Atrial fibrillation, anticoagulation, and electroconvulsive therapy

We describe our experience with six patients with atrial fibrillation (AF) during electroconvulsive therapy (ECT). In four, we observed episodic or persistent conversion of AF to normal sinus rhythm (NSR). Four patients, three with cardioversion and one without, received anticoagulation. In published case reports, ECT was successfully performed in three patients with AF without anticoagulation and in three patients with AF who received anticoagulation. In addition, 18 patients received ECT while taking concomitant anticoagulation therapy for reasons other than AF. Despite the potential risk of embolization with AF, we consider ECT may be safely administered to patients with AF. Because of the high incidence of conversion of AF to NSR, anticoagulation therapy with either warfarin or heparin is recommended.