The acute effect of bitemporal electroconvulsive therapy on synchronous changes in heart rate variability and heart rate in patients with depression

Abstract

Objective.The transient autonomic nervous system responses induced by electroconvulsive therapy (ECT) may serve as critical indicators of treatment efficacy and potential side effects; however, their precise characteristics remains unclear. Considering that the intense stimulation of ECT may disrupt the typical antagonistic relationship between the sympathetic and parasympathetic branches, this study aims to conduct a meticulous analysis of the rapid changes in heart rate variability (HRV) and HR during ECT, with a particular focus on their synchronized interplay.Methods.Pulse interval sequences were collected from 50 sessions of bitemporal ECT administered to 27 patients diagnosed with major depressive disorder. The average HR and ultra-short term HRV indices RMSSD and SDNN, as well as the Poincaré indices SD1, SD2 and SD2/SD1, were calculated using a 10 s sliding window with a step size of 1 s. In particular, the synchronous changes between SD1, SD2, SD2/SD1 and HR were analyzed.Results.The synchronous changes of the indices showed different characteristics over time. In particular, SD1, SD2 and HR increased significantly by 41.50 ± 11.45 ms, 33.97 ± 10.98 ms and 9.68 ± 2.00 bpm respectively between 8 and 20 s, whereas they decreased significantly by 19.89 ± 9.07 ms, 17.54 ± 8.54 ms and 3.80 ± 1.33 bpm respectively between 45 and 53 s after ECT stimulus onset. SD1 and SD2 both had highly significant positive correlations with HR in the above phases.Conclusion.The results suggest that bitemporal ECT induces the sympathetic and parasympathetic co-activation during the early ictal period and brief co-inhibition approximately 45 s after stimulus. Our findings may provide new insights comprehending the mechanisms of ECT and its associated cardiovascular risks.

Keywords: autonomic nervous system (ANS); co-activation; co-inhibition; electroconvulsive therapy (ECT); heart rate variability.