CARDIOVASCULAR COMPLICATIONS OF ECT IN DEPRESSED-PATIENTS WITH CARDIAC DISEASE

Objective: This study was conducted to determine the safety of electro convulsive therapy (ECT) for depressed patients with serious cardiac d isease. Method: The rate of complications in 40 patients with major de pressive disorder and left ventricular impairment, ventricular arrhyth mias, and/or conduction delay who received ECT was compared to the rat e of complications in a matched comparison group of 40 depressed patie nts without cardiac disease who also received ECT. In addition, 21 of the patients with cardiac illness had received one or more inpatient t rials of tricyclic antidepressants before receiving ECT, thereby permi tting a comparison of cardiovascular complications of medication and E CT in the same patients. Results: The patients with cardiac disease ha d a significantly higher rate of cardiac complications during ECT than did the comparison group without cardiac disease. The type of preexis ting cardiac abnormality strongly predicted the type of cardiac compli cation that occurred during ECT. However, most of the complications we re transitory and did not prevent the completion of ECT. Of the 21 pat ients with cardiac disease who had received tricyclic trials before EC T, 11 had been forced to discontinue drug treatment because of substan tial cardiovascular side effects. In comparison, 38 of the 40 cardiac patients completed the course of ECT. Conclusions: With close monitori ng for the development of arrhythmia and ischemic episodes, ECT can be given with relative safety to patients with severe cardiovascular dis ease.