Newly Published
Correspondence  |   August 2019
Cardiac Events after Electroconvulsive Therapy: Comment
Author Notes
  • Aarhus University, Aarhus, Denmark, and Aarhus University Hospital, Aarhus, Denmark (S.D.Ø). soeoes@rm.dk
  • Accepted for publication June 7, 2019.)
    Accepted for publication June 7, 2019.)×
Article Information
Correspondence
Correspondence   |   August 2019
Cardiac Events after Electroconvulsive Therapy: Comment
Anesthesiology Newly Published on August 19, 2019. doi:10.1097/ALN.0000000000002927
Anesthesiology Newly Published on August 19, 2019. doi:10.1097/ALN.0000000000002927
We read the recent paper “Major Adverse Cardiac Events and Mortality Associated with Electroconvulsive Therapy” by Duma et al.1  published in Anesthesiology with great interest. We recently wrote an article entitled “The Mortality Rate of Electroconvulsive Therapy: A Systematic Review and Pooled Analysis,”2  which has a very similar focus to that of Duma et al., but the results are strikingly different. According to Duma et al., “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,”1  which is substantially different from the results from our analyses “…yielding an [electroconvulsive therapy]–related mortality rate of 2.1 per 100,000 treatments (95% CI, 1.2 to 3.4).”2  The main reason for this discrepancy (there are also differences in the statistical approach) is that we focused exclusively on deaths that were plausibly causally related to electroconvulsive therapy, i.e., taking the timing (during or relatively soon after electroconvulsive therapy) and cause (e.g., cardiac arrest or aspiration pneumonia) into account, while Duma et al. focused on all deaths that were reported in studies of electroconvulsive therapy—irrespective of the timing and cause of death. As evident from the mortality estimates previously noted, this distinction has important consequences.