Atrial Fibrillation, Cardioversion, and Electroconvulsive Therapy

An elderly female patient with major depression and incidental atrial fibrillation received electroconvulsive therapy (ECT). Minutes after two different treatments on two separate occasions, she converted to a normal sinus rhythm. Although atrial fibrillation itself is associated with an increased risk of thromboembolic stroke, cardioversion without anticoagulation in individuals with nonacute atrial fibrillation is associated with a 1-2% incidence of embolization. Cardioversion during ECT may be infrequent but its possibility should alert clinicians to the consideration of prophylactic anticoagulation for some patients undergoing ECT.