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Asystole in Ultrabrief Pulse Electroconvulsive Therapy

Coughlin, Jennifer M. MD*; Rodenbach, Kyle*; Lee, Pin-Hsuan*; Hayat, Mathew J. PhD; Griffin, Margaret M. CRNA; Mirski, Marek A. MD, PhD*; Reti, Irving M. MD*

doi: 10.1097/YCT.0b013e31825003f9
Original Studies

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.

From the *The Johns Hopkins University School of Medicine, Baltimore, MD; †College of Nursing, Rutgers University, Newark, NJ; and ‡The Johns Hopkins Hospital, Baltimore, MD.

Received for publication February 14, 2011; accepted February 7, 2012.

Reprints: Jennifer M. Coughlin, MD, Johns Hopkins Hospital, CRBII, Room 495, Baltimore, MD 21231 (e-mail:

This research was conducted without any funding sources. There are no sources of support that require acknowledgment.

The authors have no conflicts of interest or financial disclosures to report.

© 2012 by Lippincott Williams & Wilkins