Successful Electroconvulsive Therapy in a 95-Year-Old Man With a Cardiac Pacemaker—a Case Report

Abstract

In old-old patients with major depressive disorder, electroconvulsive therapy (ECT) is relatively safe and more effective than pharmacotherapy. 1 Manly DT Oakley SP Bloch RM Electroconvulsive therapy in old-old patients. Am J Geriatr Psychiatry. 2000; 8: 232-236 Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar , 2 Tharyan P The evidence for electroconvulsive therapy (ECT) in the treatment of severe late-life depression. ECT for depressed elderly: what is the evidence and is the evidence enough?. Int Psychogeriatr. 2007; 19: 19-35 Crossref PubMed Scopus (4) Google Scholar , 3 Burd J Kettl P Incidence of asystole in electroconvulsive therapy in elderly patients. Am J Geriatr Psychiatry. 1998; 6: 203-211 Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar , 4 Salzman C Wong E Wright BC Drug and ECT treatment of depression in the elderly, 1996–2001: a literature review. Biol Psychiatry. 2002; 52: 265-284 Abstract Full Text Full Text PDF PubMed Scopus (70) Google Scholar ECT provokes unique hemodynamic changes. 5 Saito S Anesthesia management for electroconvulsive therapy: hemodynamic and respiratory management. J Anesth. 2005; 19: 142-149 Crossref PubMed Scopus (60) Google Scholar It has been applied successfully in pacemaker patients. During ECT, a pacemaker may be inhibited because of oversensing of ECT-induced myopotentials. This may result in asystole. However, studies have shown that the risks of pacemaker malfunction or cardiac complications during ECT are relatively small. 6 Dolenc TJ Barnes RD Hayes DL Rasmussen KG Electroconvulsive therapy in patients with cardiac pacemakers and implantable cardioverter defibrillators. Pacing Clin Electrophysiol. 2004; 27: 1257-1263 Crossref PubMed Scopus (49) Google Scholar , 7 Giltay EJ Kho KH Keijzer LTM Leijenaar M van Schaick HW Blansjaar BA Electroconvulsive therapy (ECT) in a patient with a dual-chamber sensing, VDDR pacemaker. J ECT. 2005; 21: 35-38 Crossref PubMed Scopus (14) Google Scholar , 8 Suzuki K Takamatsu K Takano T Tanabe Y Matsuoka H Should we convert demand mode to fixed mode when electroconvulsive therapy is administered to patients with pacemakers?. J ECT. 2009; 25: 76 Crossref PubMed Scopus (3) Google Scholar Regarding old-old patients, we found only one report of successful ECT in two patients older than 90 years with DDD and DDDR pacemakers. 6 Dolenc TJ Barnes RD Hayes DL Rasmussen KG Electroconvulsive therapy in patients with cardiac pacemakers and implantable cardioverter defibrillators. Pacing Clin Electrophysiol. 2004; 27: 1257-1263 Crossref PubMed Scopus (49) Google Scholar We present a 95-year-old patient with a VVIR pacemaker.