Asystole in ultrabrief pulse electroconvulsive therapy

Objectives: Ultrabrief (UB) pulse electroconvulsive therapy (ECT) has been gaining popularity in recent years because of its improved cognitive adverse effect profile compared with treatments triggered by brief pulses. When delivered at maximal charge, UB pulses are administered for 8 seconds. Because electrical stimulation triggers a parasympathetic surge and transient asystole, we checked whether UB pulses delivered for 8 seconds were associated with prolonged cardiac pause compared with maximal charge delivered for 4 seconds with brief pulses. Methods: This is a retrospective study of cardiac pause length of all patients undergoing ECT treatment at The Johns Hopkins Hospital during 1 year. Results: Electrocardiac pause length for patients undergoing ECT with right unilateral placement at maximal charge was not affected by pulse width. However, we did find cardiac pause length to be sensitive to 2- versus 4-second duration stimuli using brief pulses (P < 0.0001). Conclusions: Notwithstanding the clear limitations of small sample size and retrospective design, we found that right unilateral ECT was not affected by pulse width when maximal charge was delivered.