Caffeine-Associated Cardiac Dysrhythmia During ECT: Report of Three Cases.

Caffeine is increasingly being used by ECT practitioners to augment seizure duration in selected patients. We note one report of adverse cardiovascular effects with this procedure. We report three cases of severe cardiac dysrhythmia, all appearing in the present of caffeine. The three patients were elderly, with a prior history of cardiac illness. The authors recommend the use of nonpharmacologic alternatives for the treatment of brief seizures, and careful review of each patient's cardiac history before utilizing caffeine. They further urge continued monitoring in those patients for whom caffeine is introduced. Further prospective studies are needed to assess carefully the risk of caffeine pretreatment in patients with cardiac disease.