Department of Anesthesiology, and daggerDepartment of Hypertension and Cardiorenal Medicine, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan.
J ECT. 2010 Mar;26(1):41-6. doi: 10.1097/YCT.0b013e3181a95dbe.
Electroconvulsive therapy (ECT) used in the treatment of severe psychiatric disorders induces stimulation of the autonomic nervous system with initial parasympathetic outflow immediately followed by a sympathetic response. These responses induce an initial bradycardia, arrhythmias, and hypertension. QT dispersion (QTD), defined as maximal QT interval minus minimal QT interval on 12 leads of the surface electrocardiogram, reflects regional heterogeneity of ventricular repolarization. The effects of electrical stimulus due to ECT on QT interval and QTD are of considerable interest.
: This study was designed to investigate the effects of electrical stimulation caused by ECT on RR interval, QT interval, the rate-corrected QT (QTc) interval, QTD, and the rate-corrected QTD (QTcD) under general anesthesia using computerized measurements.
Thirty psychiatric patients scheduled for ECT were studied under propofol anesthesia. A 12-lead electrocardiogram was monitored to measure parameters. Muscle paralysis was achieved by administering succinylcholine 1 mg/kg intravenously, and the efficacy of ECT was determined by the tourniquet technique.
The RR interval and QT interval decreased significantly immediately after electrical stimulus, and returned to the baseline level 1 minute after electrical stimulus. In 25 out of 30 patients, the baseline value of QTc interval was higher than the normal limits, and the QTc interval decreased significantly for 2 minutes after electrical stimulus. In 27 out of 30 patients, the baseline values of QTD and QTcD were higher than the normal limits, and the QTD and QTcD increased significantly from immediately after electrical stimulus to 5 minutes after electrical stimulus.
The QTc interval, QTD, and QTcD, which were associated with increased risks of ventricular arrhythmias, increased significantly before anesthetic induction in patients with major depression. Electrical stimulus during ECT induced further increases of the QTD and QTcD.
电痉挛疗法（ECT）用于治疗严重的精神疾病，会引起自主神经系统的刺激，最初是副交感神经输出，随后是交感神经反应。这些反应会导致初始的心动过缓、心律失常和高血压。QT 离散度（QTD）定义为体表 12 导联心电图上最大 QT 间期减去最小 QT 间期，反映心室复极的区域性异质性。ECT 引起的电刺激对 QT 间期和 QTD 的影响引起了相当大的兴趣。
本研究旨在通过计算机测量，在全身麻醉下研究 ECT 引起的电刺激对 RR 间期、QT 间期、心率校正 QT（QTc）间期、QTD 和心率校正 QTD（QTcD）的影响。
研究了 30 名计划接受 ECT 的精神科患者，在丙泊酚麻醉下监测 12 导联心电图以测量参数。静脉注射琥珀胆碱 1mg/kg 以实现肌肉麻痹，并通过止血带技术确定 ECT 的疗效。
电刺激后 RR 间期和 QT 间期明显下降，电刺激后 1 分钟恢复基线水平。在 30 名患者中有 25 名，QTc 间期的基线值高于正常范围，电刺激后 2 分钟 QTc 间期明显下降。在 30 名患者中有 27 名，QTD 和 QTcD 的基线值高于正常范围，电刺激后即刻至 5 分钟 QTD 和 QTcD 明显增加。
在接受麻醉诱导之前，患有重度抑郁症的患者的 QTc 间期、QTD 和 QTcD 与室性心律失常风险增加相关，且这些值明显升高。ECT 期间的电刺激进一步增加了 QTD 和 QTcD。
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