THE EFFECT OF ESMOLOL ON ST-SEGMENT DEPRESSION AND ARRHYTHMIAS AFTER ELECTROCONVULSIVE-THERAPY

Electroconvulsive therapy (ECT) induces sympathetically mediated hemod ynamic alterations that can be associated with myocardial ischemia and arrhythmia generation. Esmolol, a short-acting beta-blocker, blunts t he hypertension and tachycardia seen with ECT. The purpose of this stu dy is to determine whether esmolol use during ECT reduces the incidenc e of myocardial ischemia or arrhythmias after ECT. In a randomized, do uble-blind placebo-controlled protocol, with each patient acting as hi s/her own control, the effects of esmolol on the incidence of myocardi al ischemia and arrhythmias were studied using two-lead Holter monitor ing for at least 2 h post-ECT. Nineteen patients underwent 71 ECT trea tments (34 placebo, 37 esmolol), recording 746 h of Holter data. The e smolol group had significantly reduced heart rate and mean arterial pr essure immediately after ECT. There was no difference in the incidence of ECG defined ischemia post-ECT between groups, with 7 of 19 (36.8%) patients in the esmolol group showing ST-segment depression compared with 5 of 19 (26.3%) in the placebo group. There was no difference bet ween groups in arrhythmia detection. This experiment demonstrates that (a) ECT is associated with a significant incidence of ST-segment depr ession, (b) esmolol blunts the sympathetic discharge during ECT, and ( c) esmolol does not reduce the incidence of post-ECT ischemia or arrhy thmia.