Hartnett Sophie, Rex Steffen, Sienaert Pascal
From the KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven, Kortenberg.
J ECT. 2023 Mar 1;39(1):3-9. doi: 10.1097/YCT.0000000000000863. Epub 2022 Jun 11.
Asystole presenting at the start of electrical stimulus application during electroconvulsive therapy (ECT) is a relatively common occurrence. It is most likely caused by vagal nerve stimulation, affecting autonomic cardiac tone. This article reviews the effect of the electrode placement (EP) on the incidence and severity of bradycardia and asystole. A systematic literature review was conducted using the Embase and PubMed databases, up to September 2021, searching for studies evaluating the effect of EP on bradycardia and/or asystole during ECT. Nine case reports describing asystole in patients receiving ECT almost exclusively reported the association with bitemporal (BT) EP. One small descriptive study found no significant effect of EP on cardiac pauses. The results from 4 cohort studies, however, suggest that a right unilateral placement bears a higher risk for developing bradycardia and asystole than BT and bifrontal ECT. The available evidence suggests that right unilateral ECT holds a greater risk for the development of bradycardia and asystole than BT and bifrontal EP.
在电休克治疗（ECT）期间，电刺激开始时出现的心搏停止是一种相对常见的情况。它最有可能是由迷走神经刺激引起的，影响自主心脏张力。本文综述了电极放置（EP）对心动过缓和心搏停止的发生率及严重程度的影响。使用Embase和PubMed数据库进行了一项系统的文献综述，截至2021年9月，搜索评估EP对ECT期间心动过缓和/或心搏停止影响的研究。九篇描述接受ECT患者心搏停止的病例报告几乎都只报道了与双侧颞部（BT）EP的关联。一项小型描述性研究发现EP对心脏停搏无显著影响。然而，4项队列研究的结果表明，与BT和双额部ECT相比，右侧单侧放置发生心动过缓和心搏停止的风险更高。现有证据表明，与BT和双额部EP相比，右侧单侧ECT发生心动过缓和心搏停止的风险更大。
