Rj. Zielinski et al., CARDIOVASCULAR COMPLICATIONS OF ECT IN DEPRESSED-PATIENTS WITH CARDIAC DISEASE, The American journal of psychiatry, 150(6), 1993, pp. 904-909
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.