Predicting postictal suppression in electroconvulsive therapy using analysis of heart rate variability

Takafumi Watanabe; Miho Miyajima; Katsuya Ohta; Noriko Yoshida; Rie Omoya; Mayo Fujiwara; Yoko Suzuki; Issei Murata; Shigeru Ozaki; Mitsuru Nakamura; Eisuke Matsushima

doi:10.1016/j.jad.2018.12.090

Predicting postictal suppression in electroconvulsive therapy using analysis of heart rate variability

J Affect Disord. 2019 Mar 1:246:355-360. doi: 10.1016/j.jad.2018.12.090. Epub 2018 Dec 25.

Authors

Affiliations

¹ Tokyo Metropolitan Health and Medical Corporation Toshima Hospital, Tokyo, Japan; Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan; Narimasu Kosei Hospital, Tokyo, Japan. Electronic address: twatlppm@tmd.ac.jp.
² Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
³ Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan; Life Sciences and Biofunctional Informatics, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan; Onda-daini Hospital, Chiba, Japan.
⁴ Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan; Narimasu Kosei Hospital, Tokyo, Japan.
⁵ Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan; Wako Hospital, Tokyo, Japan.
⁶ Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan; Onda-daini Hospital, Chiba, Japan.
⁷ Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan; International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Ibaraki, Japan.
⁸ Onda-daini Hospital, Chiba, Japan.
⁹ Tokyo Metropolitan Health and Medical Corporation Toshima Hospital, Tokyo, Japan.
¹⁰ Narimasu Kosei Hospital, Tokyo, Japan.

PMID: 30597296
DOI: 10.1016/j.jad.2018.12.090

Abstract

Background: Postictal suppression on an electroencephalogram (EEG) represents electrical silence during electroconvulsive therapy (ECT) and has been considered as a key feature associated with the efficacy of treatment. The present study aimed to predict postictal suppression using heart rate variability (HRV).

Methods: Participants comprised 21 consecutive patients with depression who underwent bilateral pulse wave ECT. We analyzed the frequency domains of resting HRV before ECT. HRV indices such as the high-frequency component (HF) reflecting parasympathetic activity and the ratio of low-frequency component (LF)/HF reflecting sympathetic activity were natural log transformed for analysis. We evaluated ictal and peri-ictal EEG parameters and investigated their associations with HRV indices.

Results: Postictal suppression and regularity were positively associated with ln[HF]. Postictal suppression remained significantly associated with ln[HF] after adjusting for age in multiple regression analysis of patients with depression.

Limitations: The present study could not examine the influence of diabetes mellitus, hypertension and polarity on HRV. In addition, the small sample size resulted in low statistical power.

Conclusions: These results suggested that ln[HF] before ECT could be utilized as a predictor of postictal suppression on EEG during ECT.

Keywords: Depression; Electroconvulsive therapy; Heart rate variability; Parasympathetic activity; Postictal suppression.

MeSH terms

Aged
Depressive Disorder / physiopathology
Depressive Disorder / therapy*
Electroconvulsive Therapy / methods*
Electroencephalography / methods
Female
Heart Rate / physiology*
Humans
Male
Middle Aged
Treatment Outcome