Journal Article

Four years experience of a nurse-led elective cardioversion service within a district general hospital setting

Rhidian J. Shelton, Alan Allinson, Tracey Johnson, Charles Smales and Gerald C. Kaye

in EP Europace

Published on behalf of European Heart Rhythm Association of the European Society of Cardiology (ESC)

Volume 8, issue 1, pages 81-85
Published in print January 2006 | ISSN: 1099-5129
Published online January 2006 | e-ISSN: 1532-2092 | DOI: http://dx.doi.org/10.1093/europace/euj009
Four years experience of a nurse-led elective cardioversion service within a district general hospital setting

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Aims External direct current cardioversion is an effective method of restoring sinus rhythm (SR) in patients with persistent atrial arrhythmias. Increasing demand for hospital beds, together with a reduction in junior doctors' hours, has adversely affected cardioversion provision. A regular nurse-led cardioversion service conducted in a dedicated hospital day-unit was introduced to resolve these constraints. There are limited data on the safety or efficacy of such a service.

Methods and results All cardioversions between October 2000 and October 2004 were performed by an appropriately trained specialist nurse, under general anaesthesia. Patients attended a pre-assessment clinic. Energy requirements for initial and subsequent defibrillations were guided by a local protocol in accordance with the guidelines from American Heart Association, American College of Cardiology, and the European Society of Cardiology. Rectilinear biphasic defibrillation was introduced in January 2004 with an appropriate protocol amendment. In the absence of complications, the aim was to discharge patients the same day. A total of 578 cardioversions (475 monophasic; 103 biphasic) were performed on 464 patients [72.1% male, mean (±SD) age 67.8±9.4 years] with atrial fibrillation (AF) (89.7%) and atrial flutter (10.3%). SR was restored in 84.0 and 100% of patients with AF and atrial flutter, respectively, which increased to 90.2 and 100% following the introduction of biphasic defibrillation. Biphasic shocks cardioverted AF with less energy (163±22 vs. 289±81 J) and less cumulative energy (230±139 vs. 455±255 J) than monophasic (P<0.001 for both), despite no difference in the duration of AF (P=0.26) or patient age (P=0.78). Two patients required hospital admission due to transient bradycardia; both were discharged within 72 h, without the need for permanent pacing. A total of 99.6% of patients was discharged home the same day; there were no deaths.

Conclusion The provision of a nurse-led elective cardioversion service is feasible and effective, without compromising safety.

Keywords: Atrial fibrillation; Atrial flutter; Cardioversion

Journal Article.  2746 words.  Illustrated.

Subjects: Cardiovascular Medicine

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