Asystole in electroconvulsive therapy: Report of four cases.
BACKGROUND
Asystole is an uncommon but potentially fatal complication of electroconvulsive therapy (ECT). Although the risk of asystole can be reduced with anticholinergic medications, the recent emphasis on new modifications of technique (first, the use of subconvulsive stimuli to titrate the seizure threshold, and second, pretreatment with intravenous beta-blockers) may increase the risk of asystole in ECT patients.


METHODS
I present four new cases of asystole in ECT and outline a scheme for anticipating and preventing asystole.


RESULTS
An episode of asystole did not prove to be an obstacle to further uncomplicated ECT.


CONCLUSIONS
If risk factors contributing to asystole are reduced and adequate doses of intravenous atropine are on hand, a patient's ECT treatments need not be interrupted.
McCall
W V
WV
Department of Psychiatry and Behavioral Medicine, Bowman Gray School of Medicine, Winston-Salem, NC 27157, USA.
D000319:Adrenergic beta-Antagonists / Q000009:adverse effects; D000328:Adult; D000368:Aged; D001285:Atropine / Q000627:therapeutic use; D003866:Depressive Disorder / Q000628:therapy; D004305:Dose-Response Relationship, Drug; D004565:Electroconvulsive Therapy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006323:Heart Arrest / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000628:therapy; D012307:Risk Factors; D013390:Succinylcholine / Q000009:adverse effects
D000319:Adrenergic beta-Antagonists; D001285:Atropine; D013390:Succinylcholine