College of Pharmacy, Southwestern Oklahoma State University, Weatherford, OK, USA.
Ann Pharmacother. 2011 Dec;45(12):1559-65. doi: 10.1345/aph.1Q393. Epub 2011 Nov 24.
To examine the evidence regarding takotsubo cardiomyopathy as a complication of electroconvulsive therapy (ECT).
Searches in MEDLINE, EMBASE, and International Pharmaceutical Abstracts (1966-August 2011) were conducted.
Published studies and case reports that mentioned takotsubo cardiomyopathy following ECT were reviewed.
Twelve case reports were available for review. There were 7 documented cases of takotsubo cardiomyopathy, 4 cases of myocardial stunning, and 1 case of cardiogenic shock following ECT. Although takotsubo cardiomyopathy was not mentioned in 5 of the cases, some clinical characteristics were consistent with this diagnosis. Left ventricular ejection fraction and the electrocardiogram returned to normal within a few days in the majority of the cases. All cases were in women, the majority of whom were postmenopausal (average age 64 years). Takotsubo cardiomyopathy developed after a single course of ECT in 6 of the cases, while the syndrome developed after more than 1 course in the other 6 cases. ECT was successfully readministered without syndrome recurrence in 4 of the cases, but only after 3 of the 4 patients received a β-adrenergic receptor blocking agent prior to each subsequent therapy session. The β-adrenergic blocking agents used were esmolol in 1 case and labetolol in the other 2.
Takotsubo cardiomyopathy is a serious but transient potential complication of electroconvulsive therapy. Limited evidence indicates that β-adrenergic receptor blocking agents may help prevent its reoccurrence in patients needing further electroconvulsive treatment. Health care providers in psychiatry should be aware of this potential complication of electroconvulsive therapy, especially in postmenopausal women. However, many questions remain regarding this issue.
探讨电抽搐治疗（ECT）后心尖球囊样综合征（takotsubo 心肌病）的发病证据。
检索 MEDLINE、EMBASE 和国际药学文摘（1966 年 8 月）。
分析发表的文献和 ECT 后发生 takotsubo 心肌病的病例报告。
共有 12 篇病例报告可用于分析。其中 7 例确诊为 takotsubo 心肌病，4 例为心肌顿抑，1 例为 ECT 后心源性休克。尽管有 5 例病例中未提及 takotsubo 心肌病，但一些临床特征与该诊断相符。大多数患者的左心室射血分数和心电图在数天内恢复正常。所有患者均为女性，大多数为绝经后妇女（平均年龄 64 岁）。6 例患者单次 ECT 后发生 takotsubo 心肌病，6 例患者多次 ECT 后发生该综合征。4 例患者在再次 ECT 前使用β肾上腺素能受体阻滞剂后成功再次治疗，而未复发该综合征，但仅 3 例患者在随后的每次治疗前使用该药物。所用的β肾上腺素能受体阻滞剂为艾司洛尔 1 例，拉贝洛尔 2 例。
心尖球囊样综合征是电抽搐治疗的一种严重但短暂的潜在并发症。有限的证据表明，β肾上腺素能受体阻滞剂可能有助于预防需要进一步电抽搐治疗的患者复发。精神科医护人员应意识到电抽搐治疗存在这种潜在并发症，尤其是绝经后妇女。但该问题仍有许多悬而未决的问题。
