Incidence of asystole in electroconvulsive therapy in elderly patients

The authors prospectively investigated the incidence of asystole (absence of heartbeat for 5 seconds) in elderly patients receiving electroconvulsive therapy (ECT) at a university-based geriatric psychiatry unit. In all, 65.8% of patients experienced asystole at some time during their course of ECT. Those who experienced asystole were significantly younger (average age, 72.2) than those without asystole (average age, 77.0; P = 0.026) and were also less likely to have cardiac rhythm disturbances on electrocardiogram (P = 0.024). Medical history, history of cardiac disease, electrode placement, energy level, and number of ECT treatments did not predict asystole. Asystole is a common side effect of ECT in elderly patients. It was not associated with any untoward outcome. The fact that "old-old" patients and those with cardiac disease are less likely to experience asystole than younger, healthier patients is reassuring to practitioners of ECT.