Electroconvulsive Therapy and Cardiac Events

Peter M. Yellowlees, MBBS, MD


May 30, 2019

This transcript has been edited for clarity.

This is the Medscape Psychiatry Minute. I'm Dr Peter Yellowlees.

Cardiac events after electroconvulsive therapy (ECT) have been reported sporadically, but a systematic assessment of the risk had previously been missing. Now a team of investigators[1] from the Medical University of Vienna, Austria, have performed a study to obtain a robust estimate of the incidence of major adverse cardiac events in adult patients undergoing ECT. They conducted a systematic review and meta-analysis of 82 studies of 106,569 patients having 786,995 ECT treatments to investigate reported major adverse cardiac events and/or mortality.

The most commonly reported major adverse cardiac events were acute heart failure, arrhythmia, and acute pulmonary edema, with 54 collective events per 1000 patients, or 8 per 1000 ECT treatments. All-cause mortality was 0.4 deaths per 1000 patients and 0.06 deaths per 1000 ECT treatments. Cardiac death accounted for 29% (23 of 79) of deaths. The investigators concluded that major adverse cardiac events and death after ECT are infrequent, occurring in approximately 1 in 50 patients and after about 1 in 200 to 500 ECT treatments.

This is an important study that quantifies the cardiac risk of ECT and shows that it is relatively low. Also, it shows that, from the perspective of cardiac risk, ECT is a safe procedure. An interesting comparison, which this study does not make, is the mortality and morbidity of patients receiving ECT versus those receiving no treatment or medications. We know that untreated depression is in itself a dangerous disorder, in terms of potential suicide and self-harm, and that all of the antidepressant medications are associated with a number of potentially serious side effects. ECT has traditionally been viewed as a safe form of treatment for depression, and this study confirms that conclusion.

Thank you for listening to this Medscape Psychiatry Minute. Do continue to enjoy your practice.

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