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Simplified cardioversion service with intravenous midazolam


Objective: To assess the results of a new cardioversion service that used intravenous midazolam sedation with cardioversion performed with a biphasic defibrillator by an experienced doctor with a prior review of patients in a pre-cardioversion clinic.

Methods: 368 consecutive patients who were treated under the new service over its first 12 months (group 1) were compared with 210 consecutive patients who attended under the old system during the preceding 12 months (group 2). Patients of group 2 had cardioversion under general anaesthesia by junior doctors with a monophasic defibrillator.

Results: There were no anaesthetic or respiratory complications in group 1. Of the patients in group 1, 10.3% remembered the shocks, with only 3.5% considering them unpleasant. Cardioversion was successful in 94.6% of group 1 patients after a mean energy of 117 J compared with 81.4% (p < 0.0001) and a mean energy of 242 J (p < 0.0001) for group 2 patients. Cancellations on the day of the procedure were reduced from 24% in group 2 to 3.4% in group 1.

Conclusions: The new service was found to be safe and more efficient. It has led to a large reduction in the waiting time for cardioversion.

  • AF, atrial fibrillation
  • AFFIRM, atrial fibrillation follow up investigation of rhythm management
  • INR, international normalised ratio
  • RACE, rate control versus electrical cardioversion for persistent atrial fibrillation
  • arrhythmias
  • atrial fibrillation
  • biphasic defibrillation
  • cardioversion
  • midazolam

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