Asystole and Electrode Placement in ECT: New Review in JECT

 Out on PubMed, in JECT, from researchers in Belgium, is this review:

Asystole During Electroconvulsive Therapy: Does Electrode Placement Matter? A Systematic Review.

Hartnett S, Rex S, Sienaert P.J ECT. 2022 Jun 11. doi: 10.1097/YCT.0000000000000863. Online ahead of print.PMID: 35700970

The abstract is copied below:
Asystole presenting at the start of electrical stimulus application during electroconvulsive therapy (ECT) is a relatively common occurrence. It is most likely caused by vagal nerve stimulation, affecting autonomic cardiac tone. This article reviews the effect of the electrode placement (EP) on the incidence and severity of bradycardia and asystole. A systematic literature review was conducted using the Embase and PubMed databases, up to September 2021, searching for studies evaluating the effect of EP on bradycardia and/or asystole during ECT. Nine case reports describing asystole in patients receiving ECT almost exclusively reported the association with bitemporal (BT) EP. One small descriptive study found no significant effect of EP on cardiac pauses. The results from 4 cohort studies, however, suggest that a right unilateral placement bears a higher risk for developing bradycardia and asystole than BT and bifrontal ECT. The available evidence suggests that right unilateral ECT holds a greater risk for the development of bradycardia and asystole than BT and bifrontal EP.

The article is here.

And from the text:





This is an excellent review of an interesting topic. The neuroanatomy of cardiac rate control is well presented. The  methodological and definitional differences in the reviewed papers (asystole, sinus pause, bradycardia) are also carefully taken into account.
The take home message that RUL has a greater likelihood of inducing transient peristimulus cardiac slowing is good to know; overall, however, this is an issue of limited clinical concern, as the vast majority of cases are self-limited, without consequences or need to intervene. But atropine should be immediately available...
(Please see also blog post of May 31, 2022  about the Trigeminocardiac reflex)

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