Atrial fibrillation (AF) remains a common arrhythmia. Electrical cardioversion is commonly employed in its management. Cardioversion needs to be carried out in a timely manner as the longer the duration of AF, the lower the success rate. Traditionally, an anaesthetist is present and administers a short acting general anaesthetic. It is often difficult to schedule cardioversions at a mutually acceptable time for both the anaesthetist and cardiologist. Recently, cardiologists have become more accustomed to the administration of conscious sedation during electrophysiology studies, and pacemaker and cardioverter-defibrillator implantations.1

We describe the use of intravenous midazolam in the setting of external electrical cardioversion for atrial flutter/fibrillation without the direct supervision of an anaesthetist.

One hundred and forty nine consecutive unselected patients (112 men and 37 women), mean (SD) age 67 (11.8) years, with haemodynamically stable persistent AF were included in this study (December 1998 to June 2000). These included patients from cardiology and general medical/geriatric outpatient departments. The 149 patients underwent a total of 169 cardioversions with 20 patients requiring more than one cardioversion on separate occasions because of recurrence of AF.

The protocol involved obtaining informed consent, ensuring adequate anticoagulation (international normalised ratio (INR) of 2.0–3.0) for at least four weeks before cardioversion. …