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Postictal asystole during ECT
Shyam K Bhat1, Daniel Acosta, Conrad M Swartz
1Department of Psychiatry, Southern Illinois University, Springfield, Illinois 62794-9642, USA.
Background:
Asystole is an uncommon but potentially fatal complication of electroconvulsive therapy (ECT). Several risks for poststimulus asystole have been described, but risks for asystole at other times have not.
Method:
Two instances of ECT postictal asystole in healthy adult males are reported. Features in common are identified.
Results:
features shared differ from risk factors for poststimulus asystole. In common were adult but not geriatric age, male sex, good physical and cardiac health, mesomorphic habitus, anticholinergic pretreatment, vigorous ECT seizure, and low resting heart rate. Both patients showed postictal bradyarrhythmia at the previous ECT.
Conclusions:
Postictal asystole has apparent similarities to postexertional asystole in athletes. The combination of higher pretreatment doses of an atropinic agent, a sympatholytic agent, and close monitoring of postictal cardiac rhythm should be considered with patients similar to ours, especially after occurrence of postictal bradyarrhythmia.