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image of Modulation of the PR Interval after Electroconvulsive Therapy in

Abstract

Introduction

Depression is a common mental disorder, often accompanied by suicidal ideation (SI). Modified electroconvulsive therapy (MECT) is widely used as an effective treatment for severe depression, especially when pharmacotherapy has failed. However, concerns regarding the potential cardiovascular effects of MECT have prompted further investigation.

Methods

A total of 100 patients with depressive disorders undergoing MECT were recruited in this study. Among them, 70 had suicide ideation (SI group) and 30 did not (non-SI group). Electrocardiogram (ECG) recordings were obtained before MECT and on the second day after several sessions of MECT treatment.

Results

After treatment with MECT, no significant differences were observed in ECG parameters, including PR intervals, QT intervals, and heart rates. However, a significant interaction between time and group on PR intervals was observed (F=5.5, 0.02). Specifically, patients in the non-SI group exhibited a slight increase in PR intervals compared with baseline values, whereas those in the SI group showed a slight decrease. More importantly, significant differences were observed between the SI and non-SI groups (Z= 2.3, 0.02). Further linear regression analysis showed that, after controlling for gender and medication types (antidepressants antipsychotics), the presence of suicide ideation was independently associated with changes in PR intervals following MECT treatment (β= 0.20, t= 2.04, 0.04).

Discussion

Our findings suggested a significant interaction between time and group on PR intervals after treatment with MECT in patients.

Conclusion

Considering that the within-group changes did not reach statistical significance, future research with a large sample size is warranted to focus on the differential effects of MECT on ECG indicators in depressed patients with or without suicide ideation.

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2026-02-20
2026-02-26
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References

  1. Suicide worldwide in 2019. 2021.World Health Organization. 2021 Available from:https://www.who.int/publications/i/item/9789240026643.
  2. Bachmann S. Epidemiology of suicide and the psychiatric perspective. Int. J. Environ. Res. Public Health 2018 15 7 1425 10.3390/ijerph15071425 29986446
    [Google Scholar]
  3. Isometsä E. Suicidal behaviour in mood disorders-Who, when, and why? Can. J. Psychiatry 2014 59 3 120 130 10.1177/070674371405900303 24881160
    [Google Scholar]
  4. Hoertel N. Franco S. Wall M.M. Oquendo M.A. Kerridge B.T. Limosin F. Blanco C. Mental disorders and risk of suicide attempt: A national prospective study. Mol. Psychiatry 2015 20 6 718 726 10.1038/mp.2015.19 25980346
    [Google Scholar]
  5. Dong M. Zeng L.N. Lu L. Li X.H. Ungvari G.S. Ng C.H. Chow I.H.I. Zhang L. Zhou Y. Xiang Y.T. Prevalence of suicide attempt in individuals with major depressive disorder: A meta-analysis of observational surveys. Psychol. Med. 2019 49 10 1691 1704 10.1017/S0033291718002301 30178722
    [Google Scholar]
  6. Al-harbi K.S. Treatment-resistant depression: Therapeutic trends, challenges, and future directions. Patient Prefer. Adherence 2012 6 369 388 10.2147/PPA.S29716 22654508
    [Google Scholar]
  7. Kellner C.H. Greenberg R.M. Murrough J.W. Bryson E.O. Briggs M.C. Pasculli R.M. ECT in treatment-resistant depression. Am. J. Psychiatry 2012 169 12 1238 1244 10.1176/appi.ajp.2012.12050648 23212054
    [Google Scholar]
  8. Fink M. Taylor M.A. Electroconvulsive therapy. JAMA 2007 298 3 330 332 10.1001/jama.298.3.330 17635894
    [Google Scholar]
  9. Group U.E.R. Efficacy and safety of electroconvulsive therapy in depressive disorders: A systematic review and meta-analysis. Lancet 2003 361 9360 799 808 10.1016/S0140‑6736(03)12705‑5 12642045
    [Google Scholar]
  10. Pagnin D. de Queiroz V. Pini S. Cassano G.B. Efficacy of ECT in depression: A meta-analytic review. J. ECT 2004 20 1 13 20 10.1097/00124509‑200403000‑00004 15087991
    [Google Scholar]
  11. Weiner R. Lisanby S.H. Husain M.M. Morales O.G. Maixner D.F. Hall S.E. Beeghly J. Greden J.F. Electroconvulsive therapy device classification: Response to FDA advisory panel hearing and recommendations. J. Clin. Psychiatry 2013 74 1 38 42 10.4088/JCP.12cs08260 23419224
    [Google Scholar]
  12. Chen X. He C. Zhang H. Yang H. Li J. The acute effect of bitemporal electroconvulsive therapy on synchronous changes in heart rate variability and heart rate in patients with depression. Physiol. Meas. 2025 46 1 015005 10.1088/1361‑6579/adaad6 39813818
    [Google Scholar]
  13. Gerring J.P. Shields H.M. The identification and management of patients with a high risk for cardiac arrhythmias during modified ECT. J. Clin. Psychiatry 1982 43 4 140 143 7068545
    [Google Scholar]
  14. Ahmadi N. Moss L. Hauser P. Nemeroff C. Atre-Vaidya N. Clinical outcome of maintenance electroconvulsive therapy in comorbid posttraumatic stress disorder and major depressive disorder. J. Psychiatr. Res. 2018 105 132 136 10.1016/j.jpsychires.2018.08.023 30219562
    [Google Scholar]
  15. Bozkurt A. Barcin C. Isintas M. Ak M. Erdem M. Ozmenler K.N. Changes in heart rate variability before and after ECT in the treatment of resistant major depressive disorder. Isr. J. Psychiatry Relat. Sci. 2013 50 1 40 46 24029110
    [Google Scholar]
  16. Longpré-Poirier C. Desbeaumes Jodoin V. Miron J.P. Fournier-Gosselin M.P. Lespérance P. Electrocardiogram corrected Q-T interval predicts response to vagus nerve stimulation in depression. J. ECT 2020 36 4 285 290 10.1097/YCT.0000000000000684 32453183
    [Google Scholar]
  17. Noda Y. Knyahnytska Y. Zomorrodi R. Downar J. Rajji T.K. Daskalakis Z.J. Blumberger D.M. Vagally mediated heart rate variability is associated with executive function changes in patients with treatment-resistant depression following magnetic seizure therapy. Neuromodulation 2022 25 8 1378 1386 10.1111/ner.13262 32870549
    [Google Scholar]
  18. Onyilo C.V. McCall W.V. Rosenquist P. Transcranial magnetic stimulation therapy of major depressive disorder improves heart rate variability. J. ECT 2022 38 2 138 140 10.1097/YCT.0000000000000823 35093970
    [Google Scholar]
  19. Rahimian A. Rahmani B. Garshad J. Salarvand A. Mansourian M. Investigating the relationship between electroconvulsive therapy and heart rate variability: A systematic review. Adv. Biomed. Res. 2023 12 1 210 10.4103/abr.abr_95_23 38073723
    [Google Scholar]
  20. Royster E.B. Trimble L.M. Cotsonis G. Schmotzer B. Manatunga A. Rushing N.N. Pagnoni G. Auyeung S.F. Brown A.R. Schoenbeck J. Murthy S. McDonald W.M. Musselman D.L. Changes in heart rate variability of depressed patients after electroconvulsive therapy. Cardiovasc. Psychiatry Neurol. 2012 2012 1 8 10.1155/2012/794043 22966422
    [Google Scholar]
  21. van Zyl L.T. Hasegawa T. Nagata K. Effects of antidepressant treatment on heart rate variability in major depression: A quantitative review. Biopsychosoc. Med. 2008 2 1 12 10.1186/1751‑0759‑2‑12 18590531
    [Google Scholar]
  22. Watanabe T. Miyajima M. Ohta K. Yoshida N. Omoya R. Fujiwara M. Suzuki Y. Murata I. Ozaki S. Nakamura M. Matsushima E. Predicting postictal suppression in electroconvulsive therapy using analysis of heart rate variability. J. Affect. Disord. 2019 246 355 360 10.1016/j.jad.2018.12.090 30597296
    [Google Scholar]
  23. Yoshida N. Miyajima M. Suzuki Y. Matsushima E. Watanabe T. Omoya R. Fujiwara M. Nakamura M. Takahashi H. Takeuchi T. Heart rate variability in schizophrenia: A comparative analysis before and after electroconvulsive therapy. Psychiatry Clin. Neurosci. Rep. 2024 3 4 e70030 10.1002/pcn5.70030 39554392
    [Google Scholar]
  24. Boscarino J.A. Chang J. Electrocardiogram abnormalities among men with stress-related psychiatric disorders: Implications for coronary heart disease and clinical research. Ann. Behav. Med. 1999 21 3 227 234 10.1007/BF02884839 10626030
    [Google Scholar]
  25. Polcwiartek C. Atwater B.D. Kragholm K. Friedman D.J. Barcella C.A. Attar R. Graff C. Nielsen J.B. Pietersen A. Søgaard P. Torp-Pedersen C. Jensen S.E. Association between ECG abnormalities and fatal cardiovascular disease among patients with and without severe mental illness. J. Am. Heart Assoc. 2021 10 2 e019416 10.1161/JAHA.120.019416 33432845
    [Google Scholar]
  26. Hartmann R. Schmidt F.M. Sander C. Hegerl U. Heart rate variability as indicator of clinical state in depression. Front. Psychiatry 2019 9 735 10.3389/fpsyt.2018.00735 30705641
    [Google Scholar]
  27. Kemp A.H. Quintana D.S. Gray M.A. Felmingham K.L. Brown K. Gatt J.M. Impact of depression and antidepressant treatment on heart rate variability: A review and meta-analysis. Biol. Psychiatry 2010 67 11 1067 1074 10.1016/j.biopsych.2009.12.012 20138254
    [Google Scholar]
  28. Yeragani V.K. Pohl R. Jampala V.C. Balon R. Ramesh C. Srinivasan K. Increased QT variability in patients with panic disorder and depression. Psychiatry Res. 2000 93 3 225 235 10.1016/S0165‑1781(00)00119‑0 10760381
    [Google Scholar]
  29. Ilter A. Aslan M. Caliskan Ilter Z. Besli F. Tusun E. Major depressive disorder is associated with fragmented QRS. Acta Cardiol. 2017 72 2 156 160 10.1080/00015385.2017.1291138 28597787
    [Google Scholar]
  30. Taylor D.M. Antipsychotics and QT prolongation. Acta Psychiatr. Scand. 2003 107 2 85 95 10.1034/j.1600‑0447.2003.02078.x 12534433
    [Google Scholar]
  31. Nielsen J. Graff C. Kanters J.K. Toft E. Taylor D. Meyer J.M. Assessing QT interval prolongation and its associated risks with antipsychotics. CNS Drugs 2011 25 6 473 490 10.2165/11587800‑000000000‑00000 21649448
    [Google Scholar]
  32. Zhong Y. Li J. Li H. Li M. Lyu Y. Cui M. Gao Y. The neuroimaging role of modified electroconvulsive therapy in the major depressive disorder: Effectiveness in first-episode antipsychotic-naive major depressive disorder patients. Depress. Anxiety 2024 2024 1 1 10 10.1155/2024/9211145 40226641
    [Google Scholar]
  33. Reilly J.G. Ayis S.A. Ferrier I.N. Jones S.J. Thomas S.H.L. QTc-interval abnormalities and psychotropic drug therapy in psychiatric patients. Lancet 2000 355 9209 1048 1052 10.1016/S0140‑6736(00)02035‑3 10744090
    [Google Scholar]
  34. Thomas S.H. Drugs Q.T. Interval abnormalities and ventricular arrhythmias. Adverse Drug React. Toxicol. Rev. 1994 13 2 77 102 7918900
    [Google Scholar]
  35. Rivas J.C. Galindo A.J. Zambrano L.F. Miranda B.C. Ramírez S.M. Rivas-Grajales A.M. Hernández-Carrillo M. Rincón E.A. Perafán P.E. Gómez-Mesa J.E. Risk of corrected QT interval prolongation in patients receiving antipsychotics. Int. Clin. Psychopharmacol., 2025 40 4 207 213.Jul 1 10.1097/YIC.0000000000000564 39082114
    [Google Scholar]
  36. Fedai Ü.A. Fedai H. The effect of electroconvulsive therapy on frontal QRS-T angle in psychiatric patients. Noro Psikiyatri Arsivi 2024 61 2 135 140 10.29399/npa.28443 38868850
    [Google Scholar]
  37. Rezaei B. Javdani H. Soleimannejad M. Dodangeh S. The effect of risperidone and electroconvulsive therapy on corrected QT interval in electrocardiogram of psychiatric patients. ARYA Atheroscler. 2021 17 4 1 6 10.22122/arya.v17i0.2235 35685233
    [Google Scholar]
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  • Article Type:
    Research Article
Keywords: electroconvulsive therapy ; electrocardiogram ; Depression ; MECT ; PR intervals ; suicide
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