Atrial fibrillation, failed cardioversion, and electroconvulsive therapy

A case is described in which an elderly male with atrial fibrillation and major depression underwent a course of electroconvulsive therapy. Two of the first three treatments were associated with other arrhythmias, during and after the procedure. Prior to the fourth treatment cardioversion was unsuccessful. During the fourth episode of electroconvulsive therapy, the patient reverted to sinus rhythm and remained in this rhythm. Reversion of atrial fibrillation to sinus rhythm may be associated with embolization if atrial thrombus has formed. Factors predisposing to changes in rhythm with electroconvulsive therapy and the management of patients with atrial fibrillation having electroconvulsive therapy are discussed.