Electroconvulsive therapy in a candidate for heart transplant with an implantable cardiovertor defibrillator and cardiac contractility modulator.

BACKGROUND: Electroconvulsive therapy (ECT) can be life-saving in treating depression, even for high-risk cardiac patients. A 56-year-old man with type 2 diabetes and dilated cardiomyopathy, using both a defibrillator and an experimental cardiac contractility modulator, had had episodes of severe depression superimposed on dysthymia for 27 years, with a current exacerbation over the past 2 years, and little response to antidepressant treatment.

METHOD: He received a course of 12 ECTs (6 right-unilateral and 6 left-anterior/right-temporal electrode placements).

RESULTS: After these, he was judged moderately but not dramatically improved.

DISCUSSION: Serious adverse events, such as myocardial infarction, lethal arrhythmias, and cardiac rupture are possible in these high-risk patients, especially those with ejection fractions <50%, previous myocardial infarction, or significant arrhythmias. This case illustrates the complex decision-making involved and the need for close interdisciplinary collaboration entailed in preparing a high-risk patient with an implanted device for ECT.