Simplified cardioversion service with intravenous midazolam

Area of Science:

• Cardiology
• Medical Services Research

Background:

• Traditional cardioversion services often involve general anesthesia and monophasic defibrillators.
• Pre-procedure patient review and experienced physician oversight are crucial for optimizing cardioversion outcomes.

Purpose of the Study:

• To evaluate the efficacy and safety of a new cardioversion service.
• To compare outcomes between a new service utilizing midazolam sedation and a biphasic defibrillator versus an older system.

Main Methods:

• A new cardioversion service (group 1) with midazolam sedation, biphasic defibrillators, and experienced physician oversight was implemented.
• Outcomes were compared to a historical group (group 2) treated under general anesthesia with monophasic defibrillators by junior doctors.
• 368 patients in group 1 were compared to 210 patients in group 2.

Main Results:

• The new service (group 1) reported no anesthetic or respiratory complications.
• Cardioversion success was significantly higher in group 1 (94.6%) compared to group 2 (81.4%) (p < 0.0001).
• On-the-day cancellations decreased from 24% to 3.4%, and mean energy used was lower in group 1 (117 J vs. 242 J).

Conclusions:

• The new cardioversion service is safe and more efficient than the previous system.
• Implementation of this service led to a substantial reduction in waiting times for cardioversion procedures.