PMID- 21205432
OWN - NLM
STAT- MEDLINE
DCOM- 20120106
LR  - 20191210
IS  - 1469-5111 (Electronic)
IS  - 1461-1457 (Linking)
VI  - 14
IP  - 5
DP  - 2011 Jun
TI  - The effect of electrode placement and pulsewidth on asystole and bradycardia 
      during the electroconvulsive therapy stimulus.
PG  - 585-94
LID - 10.1017/S1461145710001458 [doi]
AB  - Electroconvulsive therapy (ECT) is the most effective treatment for severe 
      depression, and different forms are increasingly used in clinical practice. This 
      study investigated the acute cardiac effects of different forms of ECT: 
      bitemporal and bifrontal (1.5 times seizure threshold), and right unilateral 
      (RUL) (five times seizure threshold). For RUL ECT, the effect of stimulus 
      pulsewidth (1.0 or 0.3 ms) was also examined. Electrocardiograms recorded just 
      prior to and during the ECT stimulus in 476 ECT treatments in 114 patients were 
      examined. The degree of bradycardia (any slowing of heart rate) and incidence of 
      asystole (absence of heart beats for >/=5 s) during the ECT stimulus were measured 
      from these traces. Regression analyses estimated the contribution of patient and 
      ECT treatment factors to the risk of bradycardia and asystole. Bifrontal ECT was 
      associated with less severe bradycardia than bitemporal or RUL ECT (p<0.001). 
      Modelling showed, for a mean pre-ECT heart rate of 85 beats per minute (bpm), 
      expected heart rates during the stimulus were 78 bpm (bifrontal), 46 bpm 
      (bitemporal) and 35 bpm (RUL). Bifrontal ECT was also associated with a lower 
      incidence of asystole than RUL ECT (corrected odds ratio 1:207) and bitemporal 
      ECT (corrected odds ratio 1:24). Ultrabrief pulsewidth stimulation resulted in 
      lesser bradycardia and asystole than standard pulsewidth stimulation for RUL ECT. 
      Modelling showed, for a mean pre-ECT heart rate of 86 bpm, expected heart rates 
      were 43 bpm (ultrabrief RUL) and 26 bpm (RUL). Bradycardia and asystole were 
      relatively common side-effects during the ECT stimulus. Bifrontal ECT was 
      associated with the lowest risk of bradycardia and asystole during ECT and should 
      be considered for patients at risk of arrhythmias and prolonged asystole during 
      ECT.
FAU - Stewart, Patrick T
AU  - Stewart PT
AD  - School of Psychiatry, University of New South Wales, Sydney, Australia.
FAU - Loo, Colleen K
AU  - Loo CK
FAU - MacPherson, Ross
AU  - MacPherson R
FAU - Hadzi-Pavlovic, Dusan
AU  - Hadzi-Pavlovic D
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20101223
PL  - England
TA  - Int J Neuropsychopharmacol
JT  - The international journal of neuropsychopharmacology
JID - 9815893
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Arrhythmias, Cardiac/complications/etiology/*physiopathology
MH  - Bradycardia/complications/etiology/*physiopathology
MH  - Brain/*physiology
MH  - Depressive Disorder/complications/*therapy
MH  - Electrocardiography
MH  - Electroconvulsive Therapy/adverse effects/*methods
MH  - *Electrodes
MH  - Female
MH  - Heart Arrest/complications/etiology/*physiopathology
MH  - Heart Rate
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Models, Cardiovascular
MH  - Neuropsychological Tests
MH  - Seizures/etiology
MH  - Treatment Outcome
MH  - Young Adult
EDAT- 2011/01/06 06:00
MHDA- 2012/01/10 06:00
CRDT- 2011/01/06 06:00
PHST- 2011/01/06 06:00 [entrez]
PHST- 2011/01/06 06:00 [pubmed]
PHST- 2012/01/10 06:00 [medline]
AID - S1461145710001458 [pii]
AID - 10.1017/S1461145710001458 [doi]
PST - ppublish
SO  - Int J Neuropsychopharmacol. 2011 Jun;14(5):585-94. doi: 
      10.1017/S1461145710001458. Epub 2010 Dec 23.