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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Geriatric Psychiatry
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Weiner RD
        Electroconvulsive therapy.
        in: Gabbard GO 2nd Edition. Treatment of Psychiatric Disorders. Vol 1. American Psychiatric Press, Washington, DC1995: 1237-1262
      1. Consensus Conference: electroconvulsive therapy.
        JAMA. 1985; 254: 2103-2108
        • Philbert RA
        • Richards L
        • Lynch CF
        • et al.
        Effect of ECT on mortality and clinical outcome in geriatric unipolar depression.
        J Clin Psychiatry. 1995; 56: 390-394
        • Abrams R
        Electroconvulsive Therapy. 2nd Edition. Oxford University Press, New York1992: 1-132
        • Rice EH
        • Sombrotto LB
        • Markowitz JC
        • et al.
        Cardiovascular morbidity in high-risk patients during ECT.
        Am J Psychiatry. 1994; 151: 1637-1641
        • Welch CA
        • Drop LJ
        Cardiovascular effects of ECT.
        Convuls Ther. 1980; 5: 35-43
        • Decina P
        • Malitz S
        • Sackeim HA
        • et al.
        Cardiac arrest: ECT modified β-adrenergic blockade.
        Am J Psychiatry. 1984; 141: 298-300
        • Wells DG
        • Zelcer J
        • Treadrae C
        ECT-induced asystole from a subconvulsive shock.
        Anesthesia and Intensive Care. 1988; 16: 368-373
        • Colville KI
        • Ellis CH
        • Silverstein LN
        • et al.
        Mechanisms involved in the cardiovascular response to transcranial stimulation.
        Arch Neurol Psychiatry. 1958; 80: 374-379
        • Castelli I
        • Steiner LA
        • Kaufman MA
        • et al.
        Comparative effects of esmolol and labetalol to attenuate hyperdynamic states after ECT.
        Anesth Analg. 1995; 80: 557-561
        • Thompson JW
        • Weiner RD
        • Myers CP
        An update on ECT use in the United States.
        Am J Psychiatry. 1994; 151: 1657-1661
        • Avery E
        • Winokur G
        Mortality in depressed patients treated with electroconvulsive therapy.
        Arch Gen Psychiatry. 1976; 33: 1029-1037
        • Ballentine N
        • Kettl P
        Medical Illness in the Psychiatric Patient.
        in: Gross RJ Caputo GM Kammerer and Gross' Medical Consultation. Williams & Wilkins, Baltimore, MD1998: 569-614
        • Wulfson HD
        • Askanazi J
        • Finck AD
        Propranolol prior to ECT associated with asystole.
        Anesthesiology. 1984; 60: 255-256
        • Kaufman KR
        Asystole with electroconvulsive therapy.
        J Intern Med. 1994; 235: 275-277
        • Liebowitz NR
        • El-Mallakh RS
        Cardiac arrest during ECT: a cholinergic phenomenon? (letter).
        J Clin Psychiatry. 1993; 54: 279-280
        • McCall WV
        Asystole in electroconvulsive therapy: report of four cases.
        J Clin Psychiatry. 1996; 57: 199-203
        • Nie NH
        • Hull CH
        • Jenkins JG
        • et al.
        Statistical Package for the Social Sciences, Version 7.0 for Windows–User's Guide. McGraw-Hill, New York1995
        • Bharati S
        • Lev M
        The pathologic changes in the conduction system beyond the age of ninety.
        Amer Heart J. 1992; 124: 486-496
        • Letz R
        • Gerr F
        Covariates of human peripheral nerve function, I: nerve conduction velocity and amplitude.
        Neurotoxicol Teratol. 1994; 16: 95-104
        • Hay DP
        Electroconvulsive therapy in medically ill elderly.
        Convuls Ther. 1980; 5: 8-16
        • Drop LJ
        • Welch CA
        Anesthesia for electroconvulsive therapy in patients with major cardiovascular risk factors.
        Convuls Ther. 1989; 5: 88-101
        • Brown JH
        Atropine, scopolamine, and related antimuscarinic drugs.
        in: Gilman AG Rall TW Nies N Pharmacologic Basis of Therapeutics. Pergamon, New York1990: 150-165
        • Rasmussen KG
        • Zorumski CF
        • Jarvis MR
        Asystole in ECT (letter).
        J Clin Psychiatry. 1994; 55: 313-314
      2. Physicians' Desk Reference. Medical Economics, Montvale, NJ1994: 1004-1102
        • American Psychiatric Association
        The Practice of ECT: Recommendations Practice, Training, and Privileging: Task Force Report on ECT. American Psychiatric Press, Washington, DC1990
        • Mokriski BK
        • Nagle SE
        • Papuchis GC
        • et al.
        Electroconvulsive therapy-induced cardiac arrhythmias during anesthesia with methohexital, thiamylal, or thiopental sodium.
        J Clin Anesth. 1992; 4: 208-212
        • Kramer BA
        • Afrasiabi A
        • Pollock VE
        Intravenous vs. intramuscular atropine in ECT.
        Am J Psychiatry. 1992; 149: 1258-1260