A Patient with an Implanted Cardiac Defibrillator Not Deactivated During Acute and Maintenance Electroconvulsive Therapy

Abstract

Electroconvulsive therapy (ECT) has been shown to be a safe and effective treatment for severe or medication-resistant depressive patients. 1 Although absolute contraindications no longer exist for its use, 1 patients with cardiac rhythm management devices, such as implantable cardioverter defibrillators (ICD), might represent a challenge when ECT is considered as a treatment option. ICDs have been used for more than 20 years in patients at high risk of sudden death due to ventricular arrhythmias. 2 An ICD is a device that monitors rhythm and heart rate, detects tachyarrhythmias and generates an electrical impulse to terminate them. The data generated are recorded and can be retrieved by ICD interrogation with an external programmer later on. This subgroup of patients is by no means negligible in daily psychiatric practice, as in recent years the number of ICD carriers is increasing. 3 In this context, we report the case of a 65-year-old man with recurrent Major Depressive Disorder (MDD) who had an ICD implanted and who received a course of ECT for the treatment of a psychotic depressive episode. His ICD was initially deactivated, then not deactivated, and finally he continued to receive maintenance ECT with the device activated, for a total of 70 sessions. To our knowledge, there is only one prior report of the use of ECT with an activated ICD. A 62-year-old man had his device activated while receiving ECT, under the premise of treating potential lethal arrhythmias. 4 The present case will be the first to report a sequence of acute and maintenance ECT treatment with an activated ICD and a successful outcome.