title: The safety of electroconvulsive therapy in patients with severe aortic stenosis.
abstract: Little is known about the safety of electroconvulsive therapy (ECT) in patients with severe aortic stenosis and depression and other psychiatric syndromes. We conducted a retrospective review of the medical records of 10 patients with severe aortic stenosis who underwent ECT at Mayo Clinic, Rochester, MN, between January 1, 1995, and June 30, 2006. Of the 10 patients, 6 (60%) were women. The median age was 79.5 years (range, 65-93 years). All patients had an aortic valve area of 1.0 cm2 or less (median, 0.9 cm2). The median aortic transvalvular pressure gradient was 43.5 mm Hg (range, 32-58 mm Hg). The 10 patients underwent a total of 144 ECT sessions (range, 1-37 sessions per patient). Despite this large number of sessions, only 2 patients experienced single episodes of blood pressure perceived to be low 1 minute after an electroshock; these episodes were successfully treated. Hypertensive systolic blood pressure (Greater than 180 mm Hg) and tachycardia (greater than 100 beats/min) in response to ECT prompted treatment in 7 patients during 70 ECT sessions (49%). None of the patients died within 24 hours after dismissal from the postanesthesia care unit (95% confidence interval for death rate per person, 0%-26%). Hence, ECT was safe in 10 patients with severe aortic stenosis treated at our institution. Our findings may be informative to clinicians who manage the care of patients with severe aortic stenosis who are undergoing ECT.
authors.affiliation: Division of General Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. mueller.pauls@mayo.edu
authors.forename: Paul S
authors.initials: PS
authors.lastname: Mueller
authors.forename: Roxann D
authors.initials: RD
authors.lastname: Barnes
authors.forename: Ranji
authors.initials: R
authors.lastname: Varghese
authors.forename: Rick A
authors.initials: RA
authors.lastname: Nishimura
authors.forename: Keith G
authors.initials: KG
authors.lastname: Rasmussen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications*; D001783:Blood Flow Velocity; D002389:Catatonia / Q000628:therapy*; D003863:Depression / Q000628:therapy*; D004565:Electroconvulsive Therapy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology; D007022:Hypotension / Q000209:etiology; D008297:Male; D012189:Retrospective Studies; D012449:Safety; D012720:Severity of Illness Index; D013318:Stroke Volume; D013610:Tachycardia / Q000209:etiology