Use of Electroconvulsive Therapy in a Patient with a Permanent Cardiac Pacemaker

Abstract

Abstract There is limited information on the use of electroconvulsive therapy (ECT) in patients having a cardiac pacemaker. The aim of the study was to present a case of an older woman with an implanted permanent cardiac pacemaker who presented with recurrent catatonia in the background of recurrent depressive disorder, a current episode of severe depression with psychotic symptoms, and managed with ECT. A 65-year-old female patient presented with catatonia in the background of severe depression with psychotic symptoms and marked cachexia to the emergency services for management of catatonia. Initially, she was managed with lorazepam, with which she showed improvement in catatonia. However, after 2 weeks, there was a worsening of catatonia and resultantly she was considered for ECT. In addition, she was treated with venlafaxine 150 mg/day and olanzapine 5 mg/day. She maintained well for a year, she again developed depressive, psychotic symptoms, suicidal ideations, and catatonic symptoms in the form of mutism, rigidity, negativism, and staring. Her medications were increased to tablet escitalopram 20 mg/day and tablet olanzapine 10 mg/day, but her symptoms kept worsening. The lorazepam challenge test done during this time was negative, and she was readmitted to the inpatient unit. Her medications were changed to tablet dosulepin, and she again received 15 effective ECTs. The patient was discharged on tablet dosulepin 112.5 mg/day and olanzapine 10 mg/day and maintained well for the next 6 months, i.e., until the last follow-up. ECT can be given safely in patients with depression having cardiac pacemakers with close monitoring of the cardiac parameters during ECT.