Electroconvulsive therapy in a candidate for heart transplant with an implantable cardiovertor defibrillator and cardiac contractility modulator.
BACKGROUND
Electroconvulsive therapy (ECT) can be life-saving in treating depression, even for high-risk cardiac patients. A 56-year-old man with type 2 diabetes and dilated cardiomyopathy, using both a defibrillator and an experimental cardiac contractility modulator, had had episodes of severe depression superimposed on dysthymia for 27 years, with a current exacerbation over the past 2 years, and little response to antidepressant treatment.


METHODS
He received a course of 12 ECTs (6 right-unilateral and 6 left-anterior/right-temporal electrode placements).


RESULTS
After these, he was judged moderately but not dramatically improved.


CONCLUSIONS
Serious adverse events, such as myocardial infarction, lethal arrhythmias, and cardiac rupture are possible in these high-risk patients, especially those with ejection fractions <50%, previous myocardial infarction, or significant arrhythmias. This case illustrates the complex decision-making involved and the need for close interdisciplinary collaboration entailed in preparing a high-risk patient with an implanted device for ECT.
Lynch
Alison M
AM
Dept. of Psychiatry, VCU/MCV Campus, P.O. Box 980701, Richmond, VA 23298-0710, USA. alynch2@mcvh-vcu.edu
Pandurangi
Ananda K
AK
Levenson
James L
JL
D002311:Cardiomyopathy, Dilated / Q000601:surgery*; D017147:Defibrillators, Implantable; D004565:Electroconvulsive Therapy / Q000379:methods*; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D018579:Patient Selection