Background Considerable heterogeneity exists in the shock therapy delivered during direct current cardioversion (DCCV) for arrhythmia in clinical practice. European guidelines recommend an initial synchronised shock of 120–150 J for atrial fibrillation (AF), in contrast to 200 J practiced at The Heart Hospital, London, since the introduction of a specialist nurse-led DCCV service in April 2014. Aim: To assess the clinical outcomes of DCCV at the Heart Hospital, and compliance with local and national guidelines pre- and post-introduction of a nurse-led service.

Methods Retrospective demographic, echocardiographic, ECG and DCCV data was collected from April to September 2013 and the same period in 2014 to enable a direct comparison of compliance with European Resuscitation Council and the Heart Hospital guidelines and evaluate any differences in clinical outcomes. Successful DCCV was defined as sinus rhythm on discharge.

Results 47 and 36 patients underwent DCCV between April and September in 2013 and 2014, respectively. Pre-April 2014, 61% and 16% of DCCV were compliant with national and local guidelines for AF DCCV respectively, resulting in 89% and 100% success rates. Similarly, post-April 2014 3% and 97% of DCCV were compliant with national and local guidelines respectively, resulting in 100% and 97% success rates. Following introduction of the nurse-led service, DCCV success rates increased from 80% to 92%. Follow-up waiting times pre-and post-April 2014 were 65+/-52 days and 48+/-26 days, respectively.

Conclusion Specialist-nurse led DCCV ensures a more consistent service and arguably better clinical outcomes with potential for a shorter follow-up waiting time.