Cardiac effects of electroconvulsive therapy - a systematic review

Electroconvulsive therapy (ECT) is associated with cardiovascular stress. This led to a renewal of the question concerning the short- and long-term cardiac safety of ECT. In this review, we systematically analyzed the literature concerning physiological and pathological effects of ECT on the heart with special regard to these new developments.

A systematic search in PubMed and Web of Science led to 196 studies and case reports. The results were structured according to three questions: 1. What are the general effects of ECT on the heart? 2. What are the possible cardiovascular complications and their prevalence? These publications were subcategorized into the four topics: overall complication rate, alterations of electric transmission, structural defects, and vascular problems. 3. How can such complications be avoided and managed?

In a healthy heart serious complications are very rare. In case of prior cardiac disease manifestations risk mitigation is recommended. There are no absolute cardiac contraindications against ECT.

In case of cardiac risk factors baseline measurements of surrogate markers like troponin might be beneficial. Arrhythmias and troponin level elevations are not necessarily indications of bad prognosis. Long-term cardiac effects of ECT might be beneficial through the attenuation of sympathetic activation and hormonal imbalances associated with psychiatric diseases.