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Electroshock therapy

MagazineMarch 2006 (Vol. 16 Issue 12)Electroshock therapy

Conventional treatment is often with drugs, but equally common is the use of electroshock therapy to the heart

Conventional treatment is often with drugs, but equally common is the use of electroshock therapy to the heart. Basically, this is the same defibrillation procedure used by ambulancemen in cases of cardiac arrest. But while it may be acceptable in an emergency to use a defibrillator to save life, its routine use as a therapy is questionable. After all, laymen are explicitly warned not to use DIY defibrillators if the patient still shows signs of life. Part of the reason is that the electric shock to the heart needs to be substantial (up to 360 joules), requiring the patient to be anaesthetised or, at least, sedated beforehand. There's also a vast amount of medical ignorance concerning the whole subject, with doctors openly admitting they don't really know whether the heart can be damaged by these powerful electrical shocks (Resuscitation, 2003; 59: 59-70).

What is known, however, is that electrical defibrillation can sometimes make the heart go into shock ('atrial stunning') (Int J Cardiol, 2003; 92: 113-28), and can even reduce heart output in a third of cases (Arch Intern Med, 1997; 157: 1070-6). It can even cause pulmonary oedema, a potentially fatal obstruction of the lungs (Int J Cardiol, 2003; 92: 271-4) or dislodge blood clots and precipitate a fatal stroke. Moreover, in fully a third of patients with chronic AF, defibrillation doesn't work at all (Int J Cardiol, 2005; 102: 321-6).

Most damning of all, however, is the fact that defibrillation for AF has little measurable effect on life expectancy. As a recent review of the medical records of over 4000 AF patients put it: "Large numbers of patients are needed to demonstrate even a moderate effect of AF therapy on mortality" (Heart Rhythm, 2004; 1: 531-7).

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