Leo Sher, M.D.

My note entitled “Cardiac effects of electroconvulsive therapy and psychiatric malpractice” has been published online ahead of print in the World Journal of Biological Psychiatry (1). In this note, I commented on the recently published article “Cardiac effects of electroconvulsive therapy – A systematic review” in the same journal (2).

In their systematic review, investigators from Aachen University, Germany, examined the literature concerning both the physiological and pathological cardiac effects of electroconvulsive therapy (ECT) (2). The authors conducted a comprehensive search of PubMed and Web of Science and structured their findings around three primary questions: What are the general effects of ECT on the heart? What are the possible cardiovascular complications and their prevalence? How can such complications be prevented and managed? The identified studies were further classified into four subcategories: overall complication rate, alterations in electrical conduction, structural abnormalities, and vascular complications. The authors reported that serious cardiac complications are exceedingly rare in individuals with normal cardiac function. Nevertheless, cardiovascular complications of ECT may include arrhythmias, alterations in cardiac electrical conduction, structural abnormalities such as Takotsubo cardiomyopathy, and hypertension. In patients with pre-existing cardiac disease, implementation of risk mitigation strategies is recommended. The authors further suggested that in patients with cardiovascular risk factors, baseline assessment of surrogate markers such as troponin may be useful. Importantly, they emphasized that no absolute cardiac contraindications to ECT exist.

In my commentary, I underscored that although the frequency of malpractice litigation related to ECT is relatively low, legal concerns arising from adverse effects of ECT constitute an important issue (1). Education of referring clinicians, patients, and their families regarding factors influencing the safe administration of ECT and its potential complications is essential for the prevention of malpractice claims. Furthermore, effective defense in ECT-related malpractice cases depends on meticulous documentation of pre-treatment conditions, evaluations, and procedures. It is also imperative to maintain comprehensive records of all discussions with patients and their family members, particularly those pertaining to informed consent.

References

1. Sher L. Cardiac effects of electroconvulsive therapy and psychiatric malpractice. World J Biol Psychiatry. 2025 Oct 17:1-3. doi: 10.1080/15622975.2025.2575400. Epub ahead of print.
2. Schnellbächer GJ, Vogt FJ, Hein M, Grözinger M. Cardiac effects of electroconvulsive therapy – a systematic review. World J Biol Psychiatry. 2025 Sep;26(7):313-327. doi: 10.1080/15622975.2025.2525250. Epub 2025 Jul 7.