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Atrial fibrillation debut following first electroconvulsive therapy combined with venlafaxine: a case report and a literature review

Published online by Cambridge University Press:  01 September 2022

L. Ilzarbe ,
D. Ilzarbe ,
J. Gil ,
M. Valentí ,
O. De Juan ,
N. Arbelo ,
C. Llach  and
M. Bioque
L. Ilzarbe*
Affiliation:
Hospital Clinic of Barcelona, Psychiatry And Psychology, Barcelona, Spain
D. Ilzarbe
Affiliation:
Department of Child and Adolescent Psychiatry and Psychology, Neuroscience Institute, Hospital Clinic Of Barcelona, University Of Barcelona, Idibaps, Cibersam, Barcelona, Spain
J. Gil
Affiliation:
Barcelona Bipolar Disorders Program, Neuroscience Institute, Hospital Clinic Of Barcelona, University Of Barcelona, Idibaps, Cibersam, Barcelona, Spain
M. Valentí
Affiliation:
Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona Bipolar Disorders Program, Neuroscience Institute, Barcelona, Spain
O. De Juan
Affiliation:
Hospital Clinic of Barcelona, Psychiatry And Psychology, Barcelona, Spain
N. Arbelo
Affiliation:
Hospital Clinic of Barcelona, Psychiatry And Psychology, Barcelona, Spain
C. Llach
Affiliation:
Hospital Clinic of Barcelona, Psychiatry And Psychology, Barcelona, Spain
M. Bioque
Affiliation:
Barcelona Clinic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clinic Of Barcelona, University Of Barcelona, Idibaps, Cibersambarcelona Clinic Schizophrenia Unit (bcsu), Neuroscience Institute, Barcelona, Spain
*
*Corresponding author.

Abstract

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Introduction

Cardiovascular events (CVE) are infrequent adverse effects in patients receiving electroconvulsive therapy (ECT). Nonetheless, it constitutes a threat for patient’s life and may compromise continuing ECT.

Objectives

To describe a case of acute-onset atrial fibrillation under combined therapy with ECT and venlafaxine.

Methods

We present a 76-year-old man diagnosed of delusional disorder and without any previous CVE, who was hospitalized in our acute psychiatric unit by major depressive episode with psychotic symptoms resistant to pharmacological treatment (valproic-acid 100mg/d, haloperidol 6mg/d, venlafaxine 300mg/d). ECT was initiated presenting atrial fibrillation after first session of ECT, requiring amiodarone and anticoagulant treatment for stabilization. Second session of ECT was delayed for three-weeks, worsening the psychiatric symptoms. Haloperidol was discontinued initiating lurasidone with better cardiovascular profile.

Results

CVE occur in 2% of the patients receiving ECT, being acute arrhythmia the most frequent one. Among them, few cases of atrial fibrillation (AF) under ECT have been reported. It has been hypothesised that initial vagal response followed by catecholamine surge secondary to ECT could facilitate the development of AF. In addition venlafaxine, an antidepressant drug, may also predispose to arrhythmia in high-risk individuals. High doses of venlafaxine (>300mg/d) combined with ECT have been related with an increment of CVE.

Conclusions

Although clinically effective for the treatment of major depression disorder, combined therapy of ECT and venlafaxine could precipitate the start of a CVE in genetically susceptible individuals. Therefore, identify and clarify potential risk factors other than previous history of CVE is critical to reduce morbidity and mortality in these patients.

Disclosure

No significant relationships.

Keywords

Electroconvulsive therapyCardiovascularDepression
Type
Abstract
Information
European Psychiatry , Volume 65 , Special Issue S1: Abstracts of the 30th European Congress of Psychiatry , June 2022 , pp. S560 - S561
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the European Psychiatric Association
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