title: Safety of electroconvulsive therapy in patients with a history of heart failure and decreased left ventricular systolic heart function.
abstract: OBJECTIVE
  Patients with heart failure may experience psychiatric disorders for which electroconvulsive therapy (ECT) is indicated. Little is known, however, about the safety of ECT in these patients. We assessed the safety of ECT in patients with a history of heart failure and decreased left ventricular systolic heart function.
  
  
  METHODS
  We conducted a retrospective review of the medical records of 35 patients with a history of heart failure and reduced left ventricular systolic heart function who underwent ECT at Mayo Clinic in Rochester, Minnesota, between January 1995 and December 2009.
  
  
  RESULTS
  Of the 35 patients, 18 (51%) were women. The median age was 77 years (range, 54-92 years). The median left ventricular ejection fraction was 30% (range, 15%-40%). The 35 patients underwent 513 ECT sessions (median number of sessions per patient, 10; range, 1-44). The 35 patients tolerated ECT well. No patient died or experienced decompensated heart failure, myocardial ischemia, or myocardial infarction during or within 24 hours after an ECT session. Prophylactic intravenous β-blockers were given to patients who, during previous ECT sessions, had marked hypertension (eg, systolic blood pressure >180-200 mm Hg) or a heart rate greater than 100 beats per minute; overall, this prophylaxis was used in 26 patients during 413 ECT sessions (80% of the total number of ECT sessions). Three patients experienced temporary, non-life-threatening cardiac arrhythmias.
  
  
  CONCLUSIONS
  Electroconvulsive therapy was safe in 35 patients with a history of heart failure and decreased left ventricular systolic heart function treated at our institution.
authors.affiliation: Division of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA. rivera.fernando@mayo.edu
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Rivera
authors.forename: Maria I
authors.initials: MI
authors.lastname: Lapid
authors.forename: Shirlene
authors.initials: S
authors.lastname: Sampson
authors.forename: Paul S
authors.initials: PS
authors.lastname: Mueller
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia; D000777:Anesthetics / Q000009:adverse effects / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000627:therapeutic use; D004565:Electroconvulsive Therapy / Q000009:adverse effects*; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy; D012189:Retrospective Studies; D018487:Ventricular Dysfunction, Left / Q000150:complications*
chemical_list: D000319:Adrenergic beta-Antagonists; D000777:Anesthetics; D002317:Cardiovascular Agents