Key result
Based on 4 cohort studies, right unilateral electrode placement during ECT carries a higher risk for bradycardia and asystole than bitemporal and bifrontal placement.
Why the study?
Asystole during electroconvulsive therapy is relatively common and likely vagally mediated, but the effect of electrode placement on the incidence and severity of bradycardia and asystole required review.
Does right unilateral electrode placement increase the risk of bradycardia and asystole compared to bitemporal and bifrontal placement in patients receiving ECT?
Systematic Review
Does right unilateral electrode placement increase the risk of bradycardia and asystole compared to bitemporal and bifrontal placement in patients receiving ECT?
Right unilateral electrode placement during electroconvulsive therapy is associated with a higher risk of bradycardia and asystole compared to bitemporal and bifrontal placements.
May warrant closer cardiac monitoring with right unilateral ECT; leaves open need for RCTs to confirm placement effects.
Asystole presenting at the start of electrical stimulus application during electroconvulsive therapy (ECT) is a relatively common occurrence. It is most likely caused by vagal nerve stimulation, affecting autonomic cardiac tone. This article reviews the effect of the electrode placement (EP) on the incidence and severity of bradycardia and asystole. A systematic literature review was conducted using the Embase and PubMed databases, up to September 2021, searching for studies evaluating the effect of EP on bradycardia and/or asystole during ECT. Nine case reports describing asystole in patients receiving ECT almost exclusively reported the association with bitemporal (BT) EP. One small descriptive study found no significant effect of EP on cardiac pauses. The results from 4 cohort studies, however, suggest that a right unilateral placement bears a higher risk for developing bradycardia and asystole than BT and bifrontal ECT. The available evidence suggests that right unilateral ECT holds a greater risk for the development of bradycardia and asystole than BT and bifrontal EP.
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Hartnett et al. (2022) conducted a systematic review in Electroconvulsive therapy. Right unilateral electrode placement vs. Bitemporal and bifrontal electrode placement was evaluated on Bradycardia and asystole. Based on 4 cohort studies, right unilateral electrode placement during ECT carries a higher risk for bradycardia and asystole than bitemporal and bifrontal placement.
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