Key result
Electroconvulsive therapy significantly increased the median frontal QRS-T angle from a baseline of 18 degrees to 29.5 degrees at 15 minutes post-procedure (p<0.001), which normalized within 24 hours.
Why the study?
Although electroconvulsive therapy is associated with acute cardiovascular complications, its effect on myocardial electrocardiography parameters such as frontal QRS-T angle had not been well evaluated.
Does electroconvulsive therapy alter frontal QRS-T angle, QRS duration, QT, and QTc intervals in psychiatric patients?
Cohort (n=108)
No
Does electroconvulsive therapy alter frontal QRS-T angle, QRS duration, QT, and QTc intervals in psychiatric patients?
Absolute Event Rate: 29.5% vs 18%
p-value: p=<0.001
ECT causes a transient increase in the frontal QRS-T angle at 15 minutes that normalizes by 24 hours, suggesting no permanent adverse effect on cardiovascular risk based on this parameter.
Transient fQRS-T angle widening after ECT normalizes by 24 hours; leaves open arrhythmic risk implications in psychiatric patients.
Introduction: Electroconvulsive therapy (ECT) is one of the biological therapies that is well tolerated and has a low risk of complications. Acute cardiovascular complications related to ECT such as ventricular arrhythmia, myocardial infarction and cardiac arrest have been recorded. Increased frontal QRS-T (fQRS-T) angle was associated with ventricular arrhythmia, sudden cardiac death and total mortality. In this study, we aimed to evaluate the effect of ECT on the myocardium using electrocardiography (ECG) parameters such as fQRS-T angle, QRS duration, QT and QTc interval. Methods: A total of 108 patients diagnosed with bipolar disorder (n=36), depressive disorder (n=70) and schizophrenia (n=2) who underwent ECT were included in this study. 12-lead surface ECG of all patients were taken before the ECT, 15 min. after ECT and 24 hour after ECT. Results: QRS duration, QT interval and corrected QT (QTc) interval were not changed significantly during the follow-up period. However, we found that, fQRS-T angle was significantly increased 15 minutes after ECT compared to baseline angle (p<0.001). We also detected that this increase in fQRS-T angle 15 minutes after ECT was significantly reduced 24 hours after ECT (p=0.031). Meanwhile, there was no significant difference between baseline and 24th hour fQRS-T angle (p=0.154). Conclusions: In our study, a significant increase in fQRS-T angle was observed 15 min after ECT. However, the fQRS-T angle was found to return to normal after 24 hours. Our findings may indicate that ECT does not have a permanent side effect on the risk of cardiovascular events according to the fQRS-T angle.
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Fedai et al. (2023) conducted a cohort in Psychiatric disorders (bipolar disorder, depressive disorder, schizophrenia) requiring electroconvulsive therapy (n=108). Electroconvulsive therapy (ECT) vs. Baseline (pre-ECT) was evaluated on Frontal QRS-T angle at 15 minutes post-ECT (p=<0.001). Electroconvulsive therapy significantly increased the median frontal QRS-T angle from a baseline of 18 degrees to 29.5 degrees at 15 minutes post-procedure (p<0.001), which normalized within 24 hours.
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