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Updated: Jul 10, 2025
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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
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Atrial fibrillation, electroconvulsive therapy, stroke risk, and anticoagulation
Meera Kapadia1, Pooja S Jagadish2, Marcus Hutchinson3
1Department of Internal Medicine at McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.150, Houston, TX, 77030, USA.
Summary
Electroconvulsive therapy (ECT) can alter heart rhythms, potentially increasing stroke risk, especially in patients with atrial fibrillation (AF). Anticoagulation decisions for ECT should be individualized based on stroke risk factors.
Area of Science:
- Cardiology
- Neurology
- Psychiatry
Background:
- Electroconvulsive therapy (ECT) treats severe mental health conditions.
- ECT involves electrical stimulation, posing cardiac rhythm alteration risks.
- Atrial fibrillation (AF) during ECT may increase stroke risk, necessitating risk assessment.
Purpose of the Study:
- To analyze the risk of cardiac rhythm changes during and after ECT.
- To summarize the incidence of new-onset AF and stroke post-ECT.
- To inform periprocedural risk and anticoagulation management decisions.
Main Methods:
- Systematic review of PubMed for studies on post-ECT cardioversion of AF.
- Inclusion of articles detailing new AF development or stroke after rhythm changes.
- Analysis of 14 studies involving 19 patients.
Main Results:
- Most patients experienced no rhythm changes during ECT.
- Seventeen patients developed AF post-ECT; five converted from AF to sinus rhythm.
- No strokes occurred in patients with rhythm changes, but one unanticoagulated patient with AF had a stroke post-ECT.
Conclusions:
- ECT is associated with cardiac rhythm changes, including AF development or resolution.
- Stroke risk persists during and after ECT, particularly in patients with AF.
- Individualized stroke risk assessment is crucial for anticoagulation management in ECT patients.
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