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Related Concept Videos

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Electroconvulsive therapy (ECT), or shock therapy, remains a critical biomedical intervention for severe, treatment-resistant depression. While its origins can be traced back to Hippocrates' observations that malaria-induced convulsions alleviated mental illness, modern ECT has evolved significantly from its earlier, more primitive applications. First introduced in 1938 by Ugo Cerletti and his colleagues, ECT involves inducing controlled seizures using electrical currents. In its early...
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Arrhythmia is a condition characterized by an irregular heart rhythm, with ECG changes that differ based on its origin and nature. The types of arrhythmias discussed below include atrial, junctional, and ventricular arrhythmias.Atrial ArrhythmiasPremature Atrial Complexes (PACs): PACs are early atrial beats caused by stress, caffeine, alcohol, electrolyte imbalances, hypoxia, hyperthyroidism, or certain medications (e.g., bronchodilators and decongestants). The ECG shows early P waves with an...
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Related Experiment Video

Updated: Sep 8, 2025

Non-restraining EEG Radiotelemetry: Epidural and Deep Intracerebral Stereotaxic EEG Electrode Placement
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Asystole During Electroconvulsive Therapy: Does Electrode Placement Matter? A Systematic Review.

Sophie Hartnett1, Steffen Rex, Pascal Sienaert1

  • 1From the KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven, Kortenberg.

The Journal of ECT
|June 14, 2022
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Right unilateral electrode placement during electroconvulsive therapy (ECT) may increase the risk of bradycardia and asystole compared to bitemporal or bifrontal placements. This finding is crucial for patient safety during ECT procedures.

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Area of Science:

  • Neurology
  • Cardiology
  • Psychiatry

Background:

  • Asystole and bradycardia are common during electroconvulsive therapy (ECT), often linked to vagal nerve stimulation impacting cardiac tone.
  • Understanding factors influencing these cardiac events is vital for optimizing ECT safety protocols.

Approach:

  • A systematic literature review was performed using Embase and PubMed up to September 2021.
  • Studies evaluating the impact of electrode placement (EP) on bradycardia and asystole during ECT were analyzed.

Key Points:

  • Case reports predominantly associate asystole with bitemporal (BT) electrode placement.
  • One study found no significant EP effect on cardiac pauses.
  • Four cohort studies suggest right unilateral ECT carries a higher risk of bradycardia and asystole than BT and bifrontal ECT.

Conclusions:

  • Available evidence indicates that right unilateral ECT placement poses a greater risk for bradycardia and asystole development.
  • This highlights the importance of considering electrode placement in managing cardiac risks during ECT.