External DC cardioversion is a commonly used method of terminating atrial arrhythmias. The chance of procedural success is inversely related to the duration of the arrhythmia. Rapid patient turnover is therefore of importance in managing this condition. In many hospitals, the procedure is carried out under general anaesthesia, necessitating the presence of anaesthetic as well as medical staff. Frequently, it may be difficult to coordinate the availability of the two teams, causing delays to each patient, waste of staff time, and an inefficient service. We report our experience with physician administered sedation using intravenous diazepam during DC cardioversion, without anaesthetic support. We assessed the safety, efficacy, and cost effectiveness of this approach.

One hundred and forty one patients (63% men, age (SD) 69 (11.3) years) undergoing DC cardioversion in our coronary care unit were studied over 15 months; 119 (84%) had atrial fibrillation (AF), 22 (16%) had atrial flutter. Underlying aetiology is shown in table 1. Sedation and cardioversion were carried out on each occasion by one physician and one nurse, both experienced at cardioversion and trained in advanced life support. Full resuscitation equipment, including facilities for assisted ventilation, was immediately available. Oxygen was administered continuously via a facemask. …