The safety of electroconvulsive therapy in patients with severe aortic stenosis

Little is known about the safety of electroconvulsive therapy (ECT) in patients with severe aortic stenosis and depression and other psychiatric syndromes. We conducted a retrospective review of the medical records of 10 patients with severe aortic stenosis who underwent ECT at Mayo Clinic, Rochester, MN, between January 1,1995, and June 30, 2006. Of the 10 patients, 6 (60%) were women. The median age was 79.5 years (range, 65-93 years). All patients had an aortic valve area of 1.0 cm² or less (median, 0.9 cm²). The median aortic transvalvular pressure gradient was 43.5 mm Hg (range, 32-58 mm Hg). The 10 patients underwent a total of 144 ECT sessions (range, 1-37 sessions per patient). Despite this large number of sessions, only 2 patients experienced single episodes of blood pressure perceived to be low 1 minute after an electroshock; these episodes were successfully treated. Hypertensive systolic blood pressure (>180 mm Hg) and tachycardia (>100 beats/min) in response to ECT prompted treatment in 7 patients during 70 ECT sessions (49%). None of the patients died within 24 hours after dismissal from the post-anesthesia care unit (95% confidence interval for death rate per person, 0%-26%). Hence, ECT was safe in 10 patients with severe aortic stenosis treated at our institution. Our findings may be informative to clinicians who manage the care of patients with severe aortic stenosis who are undergoing ECT.