Absence of Asystole During Bifrontal Stimulation in Electroconvulsive TherapyNagler, Josef MDJournal of ECT: June 2010 - Volume 26 - Issue 2 - pp 100-103 doi: 10.1097/YCT.0b013e3181c18926 Original Studies Abstract Author Information Cardiac action was monitored during the stimulation period of 120 consecutive electroconvulsive therapies. Electrode placement was right unilateral in 73, bitemporal in 11, and bifrontal in 36 cases. Anticholinergic premedication was routinely given. A reduction in heart rate was seen consistently with unilateral electrode placement and asystole longer than 2 seconds occurred in 63% of cases. In contrast, no asystole occurred with bifrontal electrode placement. Thus, the vagus nerve seems to be less activated during bifrontal stimulation. From the Christophsbad Clinic, Göppingen, Germany and Center of Psychiatry, Winnenden, Germany. Received for publication May 28, 2009; accepted September 14, 2009. Reprints: Josef Nagler, MD, Planckweg 4, 73035 Göppingen, Germany (e-mail: JosefNagler@gmx.de). The author has no financial support or conflict of interest associated with this submission. © 2010 Lippincott Williams & Wilkins, Inc.