Effects of atropine on hemodynamic parameters following electroconvulsive therapy: A systematic review and...

Electroconvulsive therapy (ECT) plays an important role in the treatment of refractory psychiatric disorders. However, it poses hemodynamic risks, such as blood pressure and heart rate elevation, arrhythmias, and transient asystole. Although atropine administration during ECT was considered a standard procedure in Western countries until the 1970s, in recent years, its use is generally limited to patients at high risk of bradycardia and asystole. We performed this meta-analysis of randomized controlled trials (RCTs) to understand the effects of atropine on post-ECT hemodynamics and adverse events.

A literature search of PubMed, the Cochrane Library, and Embase was conducted to identify RCTs investigating the relationship between atropine administration and post-ECT hemodynamics through September 30, 2025. The primary outcomes included maximum heart rate and maximum blood pressure after ECT, as well as the incidence of ECT-related adverse events. The secondary outcomes included seizure duration, arrhythmia incidence, severe salivation, and cognitive function.

Of the 2465 studies identified, eight RCTs were included in the meta-analysis. Maximum heart rate after ECT was significantly higher in the atropine group (p < .001). There was no significant difference in the risk of serious adverse cardiovascular events requiring intervention. Bradyarrhythmia was significantly less frequent in the atropine group (risk ratio 0.35, p < .0001).

To our knowledge, this is the first meta-analysis to evaluate the hemodynamic effects of atropine administration during ECT. The findings suggest that atropine increases maximum heart rate after ECT reduces the incidence of bradyarrhythmia. Although no increased risk of cardiovascular adverse events requiring intervention was observed, the small sample size remains an important limitation.

PROSPERO (www.crd.york.ac.uk/prospero) registration number: CRD 42022346729.