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The cardiovascular safety of the empirical measurement of the seizure threshold in electroconvulsive therapy

  • Lindsay Mizen (a1), Charles Morton (a2) and Allan Scott (a1)
Abstract
Aims and method

The Royal College of Psychiatrists' Committee on Electroconvulsive Therapy (ECT) and Related Treatments advises the measurement of initial seizure threshold in all patients undergoing ECT if possible. The subconvulsive electrical stimulation inherent in this process is thought to increase the risk of bradycardia and therefore asystole. Our aim was to establish the prevalence of asystole (no heart beat for 5 or more seconds) during empirical measurement of seizure threshold in patients who had not received anticholinergic drugs, as we were unable to find any published reports of bradycardia or asystole prevalence under these conditions. The electrocardiogram traces of 50 such consecutive patients were analysed later.

Results

Asystole occurred in 5% of stimulations. Each episode of asystole resolved spontaneously with no adverse outcomes. Contrary to expectations, asystole was no more prevalent in subconvulsive stimulations than in convulsive stimulations.

Clinical implications

There was no evidence that the empirical measurement of the seizure threshold added to the cardiovascular risk of ECT.

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Copyright
This is an open-access article published by the Royal College of Psychiatrists and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Correspondence to Lindsay Mizen (lmizen@nhs.net)
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 Abrams, R. Electroconvulsive Therapy (4th edn). Oxford University Press, 2004.
2 American Psychiatric Association Task Force 14. Electroconvulsive Therapy. American Psychiatric Press, 1978.
3 Decina, P, Malitz, S, Sackeim, HA, Holzer, J, Yudofsky, S. Cardiac arrest during ECT modified by beta-adrenergic blockade. Am J Psychiatry 1984; 141: 298300.
4 Waite, J, Easton, A (eds) The ECT Handbook (3rd edn). RCPsych Publications, 2013.
5 American Psychiatric Association Committee on Electroconvulsive Therapy. The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training and Privileging (A Task Force Report of the American Psychiatric Association). APA, 2001.
6 Bueno, CR, Rosa, MO, Rumi, DO, Ribeiro, RB, Rosa, MA. Cardiovascular safety of the methods of limit titration procedure for electroconvulsive therapy dozing: a retrospective study. Brain Stim 2011; 4: 43–5.
7 Burd, J, Kettl, P. Incidence of asystole in electroconvulsive therapy in elderly patients. Am J Geriatr Psychiatry 1998; 6: 203–11.
8 Clopper, C, Pearson, E. The use of confidence or fiducial limits illustrated in the case of the binomial. Biometrika 1934; 26: 404–13.
9 Scottish ECT Accreditation Network. Annual Report 2009. NHS National Services Scotland, 2009.
10 McCall, WV, Reid, S, Ford, M. Electrocardiographic and cardiovascular effects of subconvulsive stimulation during titrated right unilateral ECT. Convuls Ther 1994; 10: 2533.
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BJPsych Bulletin
  • ISSN: 2056-4694
  • EISSN: 2056-4708
  • URL: /core/journals/bjpsych-bulletin
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The cardiovascular safety of the empirical measurement of the seizure threshold in electroconvulsive therapy

  • Lindsay Mizen (a1), Charles Morton (a2) and Allan Scott (a1)
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