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Electroconvulsive therapy (ECT) in a patient with a dual-chamber sensing, VDDR pacemaker
Erik J Giltay1, King H Kho, L T M Keijzer
1Psychiatric Center, GGZ Delfland, Delft, The Netherlands. giltay@dds.nl
Background:
Because previous case reports involved old pacemaker models, it is unclear whether electroconvulsive therapy (ECT) may interfere with modern pacemaker function. Intracardiac voltages during ECT have not been measured previously.
Method:
We present a 77-year-old man with a dual-chamber sensing VDDR pacemaker who was treated for a major depression with ECT. His pacemaker function was closely monitored throughout the ECT sessions.
Results:
An intracardiac electrogram showed low noise signals around 2 mV during ECT, which caused oversensing in the atrium. The intracardiac electrogram and pacemaker function normalized immediately after ECT. No arrhythmias or pacemaker malfunction was detected during and after several ECT sessions.
Conclusion:
The presence of a pacemaker should not be a contraindication to receiving ECT. There was no need to convert the pacemaker to a fixed rate pacing or deactivate the pacemaker before ECT. However, careful monitoring for potential pacemaker interference by medical staff experienced in pacemaker management is advised during the first ECT sessions for patients with pacemakers.