[Asystole during electroconvulsive therapy].

BACKGROUND

Asystole during electroconvulsive therapy (ECT) has been reported as an uncommon but fatal complication. But cardiac movement during electrical stimulation has not been well known.

METHODS

The cardiac movements during electrical stimulation of fifty psychiatric patients treated by ECT under general anesthesia were observed utilizing thoracic echocardiography. Observations of 117 times were performed. Rate pressure products (RPP) immediately before stimulation and during 10 minutes after stimulation were calculated. Asystole was defined as absence of heartbeat for over 2 seconds.

RESULTS

Asystoles were observed 57 times (48.7%). The heartbeat recovered immediately after stimulation in all asystole cases. RPP increased just after stimulation in all cases. Asystole cases had significantly greater variation of RPP than cases without aystole. (P = 0.0082).

CONCLUSIONS

Electrical stimulation by ECT activates parasympathetic nervous system and convulsion by the stimulation activates sympathetic nervous system. As asystole case had good reactive automatic nervous system, asystole might have been provoked by the stimulation with a greater increase in RPP after the stimulation.