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Electroconvulsive Therapy in a Candidate for Heart Transplant With an Implantable Cardiovertor Defibrillator and Cardiac Contractility Modulator

Received January 4, 2007; revised June 5, 2007; accepted June 18, 2007. From the Department of Psychiatry, Virginia Commonwealth University, Medical College of Virginia. Send correspondence and reprint requests to Dr. A.M. Lynch, Dept. of Psychiatry, VCU/MCV Campus, P.O. Box 980701, Richmond, VA 23298–0710. e-mail: alynch2{at}mcvh-vcu.edu
© 2008 The Academy of Psychosomatic Medicine

BACKGROUND: Electroconvulsive therapy (ECT) can be life-saving in treating depression, even for high-risk cardiac patients. A 56-year-old man with type 2 diabetes and dilated cardiomyopathy, using both a defibrillator and an experimental cardiac contractility modulator, had had episodes of severe depression superimposed on dysthymia for 27 years, with a current exacerbation over the past 2 years, and little response to antidepressant treatment. METHOD: He received a course of 12 ECTs (6 right-unilateral and 6 left-anterior/right-temporal electrode placements). RESULTS: After these, he was judged moderately but not dramatically improved. DISCUSSION: Serious adverse events, such as myocardial infarction, lethal arrhythmias, and cardiac rupture are possible in these high-risk patients, especially those with ejection fractions <50%, previous myocardial infarction, or significant arrhythmias. This case illustrates the complex decision-making involved and the need for close interdisciplinary collaboration entailed in preparing a high-risk patient with an implanted device for ECT.

Key Words: ECT • Heart Transplant • Arrhythmia

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