Abstract
BackgroundFew cases of asystole or severe bradycardia occurring after the termination of seizure in the third phase with the dominance of parasympathetic nervous system activity during electroconvulsive therapy (ECT) have been reported. We describe a case of severe bradycardia occurring at the termination of seizure.Case presentationThe patient had been diagnosed with bipolar disorder more than 9 years earlier. No adverse hemodynamic events had been observed in over 100 sessions of ECT performed during a 9-year period. ECT was usually induced by propofol and suxamethonium. On this ECT, the heart rate gradually decreased before seizure termination, and severe bradycardia (5–6 beats/min) was identified lasting 15–20 s. Atropine administration immediately before electrical stimulus prevented any further bradycardia during the next session of ECT.ConclusionsThis case report indicates that attention should be paid to adverse cardiac events related to autonomic nerve activity even before such events occur during ECT.
Highlights
Few cases of asystole or severe bradycardia occurring after the termination of seizure in the third phase with the dominance of parasympathetic nervous system activity during electroconvulsive therapy (ECT) have been reported
This case report indicates that attention should be paid to adverse cardiac events related to autonomic nerve activity even before such events occur during ECT
We describe a case in which severe bradycardia occurred before seizure termination in the third phase of parasympathetic dominance
Summary
Electroconvulsive therapy (ECT) is performed worldwide as an effective therapeutic option to relieve symptoms of psychiatric depression [1]. Bradycardia is severe, and temporary asystole can be observed [2, 3] This first phase is completed within 1 min, and the ensuing second phase of sympathetic activation induces tachycardia and elevated blood pressure, with drastic hemodynamic changes lasting > 10 min after electrical stimulation [1, 4]. No abnormalities were identified on echocardiography, with no asynergy of the left ventricle (LV) and an LV ejection fraction of 60–65% At this time, treatment with maintenance ECT was planned to be continued as usual, along with pharmacotherapy comprising oral olanzapine at 5 mg/day. For the ECT procedure, 0.5 mg of atropine sulfate was infused immediately before the electrical stimulus, and no adverse hemodynamic changes, asystole, or severe bradycardia were found during ECT (Fig. 2)
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