The safety and effectiveness of a nurse led cardioversion service under sedation

Abstract

Objective: To assess the safety and effectiveness of nurse led elective cardioversion of atrial fibrillation under sedation. Design: Prospective, longitudinal study. Setting: Cardiac catheterisation laboratory and recovery area of a district general hospital. Patients: 300 patients referred for elective cardioversion of persistent atrial fibrillation. Interventions: Pre-procedure evaluations (history, physical examination, blood tests), consent, sedation administration, cardioversions, and post-procedure monitoring until discharge by advanced life support certified coronary care unit nurses trained in the techniques. A doctor was immediately available if required but not present. Main outcome measures: Success rates at discharge and at six weeks, energy delivered, number of shocks, dose of sedation, immediate, 24, and 48 hour patient perceptions, complications, waiting times, and cost effectiveness. Results: Cardioversion success rate was 87% at discharge and 48% at six weeks. Mean (SD) cumulative energy was 497 (282) J and number of shocks 1.6 (0.8). Mean (SD) dose of sedation was 23 (9) mg intravenous diazepam. No patient required reversal of sedation, airway support, or medical intervention. Ninety eight per cent of patients had no pain or recall of the procedure. Four patients who were adequately anticoagulated experienced embolic phenomena. Ninety eight per cent of patients would repeat the procedure if necessary. Without requirement for a physician or anaesthetist, waiting times for elective cardioversion fell from three months to under four weeks. There was a significant reduction in the estimated cost of the procedure from £337 with general anaesthesia to £130 with nurse led sedation and cardioversion (p , 0.001). Conclusion: With appropriate training, a nurse led cardioversion service with sedation is safe, effective, well tolerated, and cost efficient.

Treating the right patient at the right time: An innovative approach to the management of atrial fibrillation

“…The use of trained nurse clinicians has been reported to provide a timely, safe and efficacious cardioversion service for the treatment of AF in the United Kingdom, where doctor shortages have created prolonged access times for this procedure (8,9). In addition, the use of nurse clinicians to titrate drug doses for patients with congestive heart failure has been shown to significantly improve compliance of drug therapy for heart failure and to improve clinical outcomes (10,11).…”

A Five Year Audit of DC Cardioversion for Patients with Atrial Fibrillation in East London

“…Furthermore, the success rate was sustained for 59% to 61% of patients at sixweeks follow-up. This too was extremely impressive considering that the rates found during our literature review at similar time scales was 37% to 51% [8,[11][12][13].…”

“…For this reason, we considered a range of four to eight-weeks for follow-up to determine success. We found in the literature that this ranged from 37% to 51% [8,[11][12][13]. We therefore set this standard at greater than 51%.…”

Feasibility of a cardiologist-only approach to sedation for electrical cardioversion of atrial fibrillation: A randomized, open-blinded, prospective study

“…Among alternatives, midazolam possesses some requisites in order to be easily handled by the cardiologist alone due to its short-acting kinetic, optimal safety profile and antidote availability. Unfortunately, previous evidence on midazolam derived only from retrospective registries, [20] non-randomized trials, [21] or even uncontrolled studies [22].…”