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Related Experiment Videos

Diazepam or midazolam for external DC cardioversion (the DORM Study).

A R J Mitchell1, S Chalil, L Boodhoo

  • 1The Department of Cardiology, Eastbourne General Hospital, Eastbourne, UK. mitcharj@doctors.org.uk

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|February 3, 2004
PubMed
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Diazepam demonstrated fewer adverse events and faster recovery than midazolam for physician-led DC cardioversion. Both sedatives were effective for atrial arrhythmias, with no long-term recall issues.

Area of Science:

  • Cardiology
  • Pharmacology
  • Anesthesiology

Background:

  • Physician-led DC cardioversion is a standard treatment for atrial arrhythmias.
  • Intravenous sedatives are commonly used to improve patient comfort and procedural success.
  • Comparing the efficacy and tolerability of different sedatives is crucial for optimizing patient care.

Purpose of the Study:

  • To compare the clinical efficacy and tolerability of midazolam versus diazepam for intravenous sedation during physician-led DC cardioversion of atrial arrhythmias.

Main Methods:

  • A randomized trial involving 141 patients undergoing elective DC cardioversion for atrial arrhythmias.
  • Patients were randomized to receive either intravenous midazolam or diazepam, administered via titration protocols.
  • Outcomes assessed included procedure times, operator satisfaction, adverse events, and patient recall/awareness of after-effects at 24 and 48 hours.

Related Experiment Videos

Main Results:

  • Diazepam (n=70) was associated with significantly shorter sedation times (6.5 min vs. 5.0 min for midazolam, P=0.0016) and quicker recovery (39 min vs. 77 min post-sedation, P<0.0001).
  • Minor adverse events were less frequent with diazepam (9 events) compared to midazolam (16 events), though not statistically significant (P=0.14).
  • No major adverse events or differences in procedural recall at 48 hours were observed between the groups.

Conclusions:

  • Intravenous sedation for physician-led cardioversion of atrial arrhythmias is effective and well-tolerated.
  • Diazepam offers advantages over midazolam, including reduced minor adverse events and faster patient recovery.
  • Both sedatives provide adequate procedural conditions and do not lead to persistent awareness of the cardioversion procedure.