ECT and the EKG: New Article From Turkey

 Out on PubMed, from authors in Turkey, is this article:

The Effect of Electroconvulsive Therapy on Frontal QRS-T Angle in Psychiatric Patients.

Fedai ÜA, Fedai H.Noro Psikiyatr Ars. 2024 May 29;61(2):135-140. doi: 10.29399/npa.28443. eCollection 2024.PMID: 38868850

The abstract is copied below:

Introduction: Electroconvulsive therapy (ECT) is one of the biological therapies that is well tolerated and has a low risk of complications. Acute cardiovascular complications related to ECT such as ventricular arrhythmia, myocardial infarction and cardiac arrest have been recorded. Increased frontal QRS-T (fQRS-T) angle was associated with ventricular arrhythmia, sudden cardiac death and total mortality. In this study, we aimed to evaluate the effect of ECT on the myocardium using electrocardiography (ECG) parameters such as fQRS-T angle, QRS duration, QT and QTc interval.

Methods: A total of 108 patients diagnosed with bipolar disorder (n=36), depressive disorder (n=70) and schizophrenia (n=2) who underwent ECT were included in this study. 12-lead surface ECG of all patients were taken before the ECT, 15 min. after ECT and 24 hour after ECT.

Results: QRS duration, QT interval and corrected QT (QTc) interval were not changed significantly during the follow-up period. However, we found that, fQRS-T angle was significantly increased 15 minutes after ECT compared to baseline angle (p<0.001). We also detected that this increase in fQRS-T angle 15 minutes after ECT was significantly reduced 24 hours after ECT (p=0.031). Meanwhile, there was no significant difference between baseline and 24th hour fQRS-T angle (p=0.154).

Conclusions: In our study, a significant increase in fQRS-T angle was observed 15 min after ECT. However, the fQRS-T angle was found to return to normal after 24 hours. Our findings may indicate that ECT does not have a permanent side effect on the risk of cardiovascular events according to the fQRS-T angle.

Keywords: Cardiovascular side effect; electrocardiography; electroconvulsive therapy; frontal QRS-T angle.

The article is here.

And from the text:

Here is an interesting little study for ECT practitioners with a cardiologic bent. 

Who knows if the Frontal QRS-T angle is a relevant marker for cardiac risk?

It would have been nice to have another time point for comparison (say 30 or 60 minutes) to know if the period for potential risk extends beyond the time in the recovery area.

And I note the routine use of rocuronium, which seems unusual.

But overall kudos to our Turkish colleagues for this contribution to the ECT anesthesia/cardiac/medical literature.