ABSTRACT
BACKGROUND: The purpose of this study was to compare the safety, efficacy, and cost of conscious sedation administered by electrophysiologists certified in the use of conscious sedation with sedation administered by anesthesiologists during cardioversion of atrial fibrillation or atrial flutter to sinus rhythm. METHODS AND RESULTS: Patients with hemodynamically stable persistent atrial fibrillation and flutter were included in this study. Group 1 patients (n = 33) were sedated by an anesthesiologist and group 2 patients (n = 26) were sedated by an electrophysiologist. Anesthesiologists used propofol and electrophysiologists used midazolam and morphine for sedation. A cost analysis based on professional charges and cost of medications was performed for both groups and compared. Hospital charges were similar for both groups and were excluded from the cost analysis. Although time to sedation in group 1 was shorter than that in group 2, sedation was adequate in both groups such that no patient in group 1 and only 1 patient in group 2 recalled being shocked. There were no complications in either group. The cost incurred in group 2 was less than that in group 1. CONCLUSIONS: Sedation administered by electrophysiologists for cardioversion of atrial arrhythmias is safe and cost effective. Midazolam and morphine, the sedative agents administered by electrophysiologists, were effective and well tolerated by patients.
Subject(s)
Anesthesia Department, Hospital/economics , Atrial Fibrillation/therapy , Atrial Flutter/therapy , Conscious Sedation/economics , Electric Countershock , Aged , Aged, 80 and over , Analgesics, Opioid , Anesthesia Department, Hospital/standards , Anesthesiology , Anesthetics, Intravenous , Atrial Fibrillation/economics , Atrial Flutter/economics , Conscious Sedation/methods , Cost Control , Electrophysiology , Female , Hospital Charges , Humans , Male , Midazolam , Middle Aged , New York , PropofolABSTRACT
The need for thoracotomy has previously limited the use of the implantable cardioverter-defibrillator. Prior investigators have shown the efficacy and reduced risk of the transvenous implantable cardioverter-defibrillator. In this study, we report our experience with the transvenous implantable cardioverter-defibrillator as a first-line system. Thirty-four patients with mean age 63.2 +/- 10.3 years and mean ejection fraction 32.6 +/- 11.4% underwent implantation of a transvenous cardioverter-defibrillator using an Endotak lead with or without a subcutaneous patch. Twenty-one patients received a biphasic device and the remainder a monophasic device. Thirty-three of 34 patients (97%) were successfully implanted. The mean defibrillation threshold was than < or = 15.3 +/- 3.6J. Overall, 25 of 34 (74%) patients were implanted with a single endocardial lead alone. In the group receiving a biphasic device 19 of 21 (90%) were successfully implanted with a single endocardial lead alone whereas in the group receiving a monophasic device only 6 of 12 (50%) were successfully implanted with single endocardial lead alone (p < 0.05). There were no serious complications. One postoperative death was a result of end-staged congestive heart failure. We conclude that the transvenous implantable cardioverter-defibrillator is safe and efficacious and that incorporation of biphasic waveform may lead to higher rates of implantation of single transvenous lead alone without the need for subcutaneous patch.
Subject(s)
Defibrillators, Implantable , Ventricular Fibrillation/therapy , Adult , Aged , Female , Follow-Up Studies , Humans , Male , Middle AgedABSTRACT
Electromagnetic interference can cause implanted devices (pacemakers and defibrillators) to malfunction. This article reviews four cases of device interference and provides a review of the literature, and our recommendations for managing these problems.
