{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T09:50:39Z","timestamp":1782467439065,"version":"3.54.5"},"reference-count":17,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PCN Reports"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Electroconvulsive therapy (ECT) is highly effective for severe or treatment\u2010resistant major depressive disorder, including in older adults. In patients with permanent pacemakers, however, ECT may be avoided because of concern about device malfunction or arrhythmia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>We report a man in his 80s with recurrent major depressive disorder and a dual\u2010chamber pacemaker for complete atrioventricular block. During the approximately 2 years before admission, the depressive episode achieved only partial remission despite mirtazapine 30\u2009mg\/day and trials of duloxetine 60\u2009mg\/day and venlafaxine 150\u2009mg\/day, then worsened acutely. Vortioxetine was introduced after admission, but severe symptoms persisted. Pre\u2010ECT interrogation confirmed pacemaker dependence with only minimal intrinsic ventricular activity. After multidisciplinary preparation, approximately twice\u2010weekly ECT was initiated using a Thymatron System IV device with initial bitemporal placement; stimulus dosing initially followed the half\u2010age method, beginning at 40% (202 mC) with a brief\u2010pulse stimulus. As seizure induction became difficult, augmentation included hyperventilation, theophylline premedication, switching to right unilateral placement, and ketamine anesthesia. Continuous monitoring and peri\u2010ECT device checks showed stable function; no magnet application or reprogramming was required. The patient received 20 treatments. The 21\u2010item GRID Hamilton Depression Rating Scale (GRID\u2010HAM\u2010D) score improved from 32 before ECT to 2 after the acute course. Mood, anxiety, appetite, and physical strength improved early, followed by more gradual improvement in psychomotor retardation. No clinically significant arrhythmias, pacemaker malfunction, oversensing, pacing inhibition, or serious hemodynamic complications occurred.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case supports the feasibility of carefully planned ECT in selected older patients with permanent pacemakers, provided that multidisciplinary planning and practical device precautions are in place.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pcn5.70348","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T04:09:57Z","timestamp":1779163797000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Electroconvulsive therapy in an older patient with recurrent major depressive disorder and a permanent pacemaker: A case 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