The effect of esmolol on ST-segment depression and arrhythmias after electroconvulsive therapy
D A Zvara1, R F Brooker, W V McCall
1Department of Anesthesia, The Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina 27157-1009, U.S.A.
Insights
Esmolol, a beta-blocker, blunts sympathetic responses during electroconvulsive therapy (ECT). However, this study found esmolol did not reduce myocardial ischemia or arrhythmias after ECT, despite its hemodynamic effects.
Area of Science:
- Cardiology
- Psychiatry
- Pharmacology
Background:
- Electroconvulsive therapy (ECT) can cause significant hemodynamic changes, including hypertension and tachycardia.
- These changes are mediated by sympathetic nervous system activation and may increase the risk of myocardial ischemia and arrhythmias.
- Esmolol, a short-acting beta-blocker, is known to mitigate these acute hemodynamic alterations.
Purpose of the Study:
- To investigate whether esmolol administration during ECT reduces the incidence of post-ECT myocardial ischemia.
- To determine if esmolol use during ECT decreases the occurrence of arrhythmias following the procedure.
Main Methods:
- A randomized, double-blind, placebo-controlled crossover study was conducted.
- Patients received both esmolol and placebo during separate ECT sessions, acting as their own controls.
- Two-lead Holter monitoring was used for at least 2 hours post-ECT to assess cardiac events.
Main Results:
- Esmolol significantly reduced heart rate and mean arterial pressure immediately after ECT compared to placebo.
- No significant difference was observed in the incidence of electrocardiogram (ECG)-defined myocardial ischemia between the esmolol and placebo groups.
- The detection rates for arrhythmias were similar in both the esmolol and placebo treatment arms.
Conclusions:
- ECT is associated with a notable incidence of ST-segment depression, indicating myocardial ischemia.
- Esmolol effectively blunts the sympathetic surge during ECT, as evidenced by reduced heart rate and blood pressure.
- Despite blunting sympathetic discharge, esmolol does not appear to decrease the risk of post-ECT myocardial ischemia or arrhythmias.
Abstract:
Electroconvulsive therapy (ECT) induces sympathetically mediated hemodynamic alterations that can be associated with myocardial ischemia and arrhythmia generation. Esmolol, a short-acting beta-blocker, blunts the hypertension and tachycardia seen with ECT. The purpose of this study is to determine whether esmolol use during ECT reduces the incidence of myocardial ischemia or arrhythmias after ECT. In a randomized, double-blind, placebo-controlled protocol, with each patient acting as his/her own control, the effects of esmolol on the incidence of myocardial ischemia and arrhythmias were studied using two-lead Holter monitoring for at least 2 h post-ECT. Nineteen patients underwent 71 ECT treatments (34 placebo, 37 esmolol), recording 746 h of Holter data. The esmolol group had significantly reduced heart rate and mean arterial pressure immediately after ECT. There was no difference in the incidence of ECG defined ischemia post-ECT between groups, with 7 of 19 (36.8%) patients in the esmolol group showing ST-segment depression compared with 5 of 19 (26.3%) in the placebo group. There was no difference between groups in arrhythmia detection. This experiment demonstrates that (a) ECT is associated with a significant incidence of ST-segment depression, (b) esmolol blunts the sympathetic discharge during ECT, and (c) esmolol does not reduce the incidence of post-ECT ischemia or arrhythmia.
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