Newly Published
Perioperative Medicine  |   October 2018
Major Adverse Cardiac Events and Mortality Associated with Electroconvulsive Therapy: A Systematic Review and Meta-analysis
Author Notes
  • From the Departments of Anesthesiology and Intensive Care (A.D., M.M., B.P.) and Emergency Medicine (H.H.), Medical University of Vienna, Vienna, Austria; and the Department of Anesthesiology, Washington University, St. Louis, Missouri (P.N.), Department of Public Health Sciences, University of Chicago, University of Chicago, Illinois (T.K.).
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    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Part of the work presented in this article has been presented as abstract A1093 at the American Society of Anesthesiologists Annual Meeting in Boston, Massachusetts, October 21, 2017.
    Part of the work presented in this article has been presented as abstract A1093 at the American Society of Anesthesiologists Annual Meeting in Boston, Massachusetts, October 21, 2017.×
  • Submitted for publication January 12, 2018. Accepted for publication September 24, 2018.
    Submitted for publication January 12, 2018. Accepted for publication September 24, 2018.×
  • Correspondence: Address correspondence to Dr. Nagele: University of Chicago, 5841 S. Maryland Avenue, MC 4028, Room E-422, Chicago, Illinois 60637-1470. pnagele@dacc.uchicago.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Cardiovascular Anesthesia
Perioperative Medicine   |   October 2018
Major Adverse Cardiac Events and Mortality Associated with Electroconvulsive Therapy: A Systematic Review and Meta-analysis
Anesthesiology Newly Published on October 23, 2018. doi:10.1097/ALN.0000000000002488
Anesthesiology Newly Published on October 23, 2018. doi:10.1097/ALN.0000000000002488
Abstract

Editor’s Perspective:

What We Already Know about This Topic:

  • The incidence of major adverse cardiac events after electroconvulsive therapy is not known

What This Article Tells Us That Is New:

  • Major adverse cardiac events and death after electroconvulsive therapy are infrequent and occur in about 1 of 50 patients and after about 1 of 200 to 500 electroconvulsive therapy treatments

Background: Cardiac events after electroconvulsive therapy have been reported sporadically, but a systematic assessment of the risk is missing. The goal of this study was to obtain a robust estimate of the incidence of major adverse cardiac events in adult patients undergoing electroconvulsive therapy.

Methods: Systematic review and meta-analysis of studies that investigated electroconvulsive therapy and reported major adverse cardiac events and/or mortality. Endpoints were incidence rates of major adverse cardiac events, including myocardial infarction, arrhythmia, pulmonary edema, pulmonary embolism, acute heart failure, and cardiac arrest. Additional endpoints were all-cause and cardiac mortality. The pooled estimated incidence rates and 95% CIs of individual major adverse cardiac events and mortality per 1,000 patients and per 1,000 electroconvulsive therapy treatments were calculated.

Results: After screening of 2,641 publications and full-text assessment of 284 studies, the data of 82 studies were extracted (total n = 106,569 patients; n = 786,995 electroconvulsive therapy treatments). The most commonly reported major adverse cardiac events were acute heart failure, arrhythmia, and acute pulmonary edema with an incidence (95% CI) of 24 (12.48 to 46.13), 25.83 (14.83 to 45.00), and 4.92 (0.85 to 28.60) per 1,000 patients or 2.44 (1.27 to 4.69), 4.66 (2.15 to 10.09), and 1.50 (0.71 to 3.14) per 1,000 electroconvulsive therapy treatments. All-cause mortality was 0.42 (0.11 to 1.52) deaths per 1,000 patients and 0.06 (0.02 to 0.23) deaths per 1,000 electroconvulsive therapy treatments. Cardiac death accounted for 29% (23 of 79) of deaths.

Conclusions: Major adverse cardiac events and death after electroconvulsive therapy are infrequent and occur in about 1 of 50 patients and after about 1 of 200 to 500 electroconvulsive therapy treatments.