Tang W K, Ungvari G S
Department of Psychiatry, The Chinese Univeersity of Hong Kong, Prince of Wales Hospital, Shatin, NT.
Aust N Z J Psychiatry. 2001 Jun;35(3):382-5. doi: 10.1046/j.1440-1614.2001.00892.x.
The objective of the report is to describe a case of asystole lasting for 18 s, which developed after a subconvulsive stimulus during electroconvulsive therapy (ECT) in a patient without pre-existing cardiovascular abnormality. A brief review of the relevant literature is also provided.
The patient was a 65-year-old Chinese man with a 2-year history of depression and good past medical health. Earlier he had responded well to a course of ECT without adverse effects. This time he presented with low mood, anhedonia, poor appetite and constipation. He did not respond to adequate trials with several antidepressant medications. When a subconvulsive stimulus was administered to determine the seizure threshold, no seizure activity was detected. However, immediately after the stimulus the patient developed an 18-s asystole, followed by bradycardia of 40 beats per minute for 10 s. The bradycardia resolved spontaneously before therapeutic intervention was effected.
Intravenous atropine was employed as premedication and suprathreshold stimulus was used in further ECT sessions.
Asystole did not recur in the subsequent six ECT sessions.
When proper precautions are taken, asystole does not necessitate the suspension of further ECT sessions but intravenous atropine should be considered as premedication in such cases. Inducing anaesthesia with methohexital, avoiding excessive amounts of succinylcholine and employing suprathreshold stimulus and unilateral electrode placement may further lessen the likelihood of asystole in susceptible cases.
本报告旨在描述一例心脏停搏持续18秒的病例，该病例发生在一名无心血管异常病史的患者接受电休克治疗（ECT）时的亚惊厥刺激之后。同时还提供了相关文献的简要综述。
患者为一名65岁的中国男性，有2年抑郁症病史，既往身体健康。此前他接受过一个疗程的ECT治疗，反应良好，无不良反应。此次他表现为情绪低落、快感缺失、食欲减退和便秘。他对多种抗抑郁药物的充分试验均无反应。在给予亚惊厥刺激以确定癫痫阈值时，未检测到癫痫活动。然而，刺激后立即患者出现了18秒的心脏停搏，随后出现每分钟40次的心动过缓，持续10秒。在进行治疗干预之前，心动过缓自行缓解。
静脉注射阿托品作为术前用药，在后续的ECT治疗中使用阈上刺激。
在随后的6次ECT治疗中未再出现心脏停搏。
当采取适当预防措施时，心脏停搏并不一定需要暂停进一步的ECT治疗，但在这种情况下应考虑将静脉注射阿托品作为术前用药。用美索比妥诱导麻醉、避免过量使用琥珀酰胆碱、采用阈上刺激和单侧电极放置可能会进一步降低易感病例发生心脏停搏的可能性。
