Electroconvulsive therapy with a cardiac pacemaker

Abstract

No implanted pacemaker appears to be affected by the current produced by electroconvulsive therapy. Proper grounding of all electrical monitoring devices is essential so that no current passes over the implanted low resistance pathway to the myocardium. Care must be taken to insure that there are no defects in the pacemaker insulation and that no low resistance contact exists between the patient and true ground. Atropine, although valuable as an antisialogogue, can be omitted from preanesthetic medication in pacemaker patients if desired, as it can precipitate atrial arrhythmias necessitating pharmacologic or electroconversion. Additionally, the pacemaker provides 'built in' protection against vagotonic bradyarrhythmias. The reported case supports the safety of using electroconvulsive therapy for patients who have cardiac pacemakers.