medigraphic.com
ISSN 1405-0315 (Print)

2001, Number 1-4

<< Back Next >>

Rev Mex Enf Cardiol 2001; 9 (1-4)

External electric cardioversion in the electrophysiology laboratory (EPL) with transitory hospitalization system: An alternative modality

Baeza LM, Cambón AM, Collinao RM

Language: Spanish
References: 17
Page: 6-10
PDF size: 154.49 Kb.


ABSTRACT

The external electric cardioversion (EEC) is an effective alternative for the treatment of arrhythmias in a select group of patients requiring hospitalization, high technology and qualified medical equipment which involve important economic costs, achieving a 70-90% of success. The objective of the investigation was to analize the EEC performed in the electrophysiology laboratory (EPL) in patients with traditional and transitory hospitalization. One hundred percent of the EEC performed in the EPL between August 2000 and 2001 (n=40) as well as the analysis of clinical characteristics, results and involved costs were included in a prospective an descriptive way.
Results: 67% males, average age 64 yrs., 67.5% diagnosed with auricular fibrillation, 27% with cardiovascular risk factors, 90% with previous antiarrhythmic treatment, and 88% with anticoagulant treatment, 45% with previous EEC. In 38% the arrhythmia data was from one to three months, sedation with two drugs was used in 68% of the cases, the most frequent combination being midazolam-morphine. The EEC was successful in 90% of the cases, being in the less than one month group 100% effective. The discharge number has a statistically significant association with arrhythmic duration (p‹ 0.001). Adverse effects were present in 5% of the cases, requiring a 7% reversion of sedation. Postoperatory amnesia reached 98%, the patient was in EPL an average of 67 minutes. The average cost of the treatment was $104.220 (30.527244.723), the cost variation is statistically significant depending on the post EEC destination place (p‹ 0.001).
Conclusions: The EEC performed in the EPL offers a safe, efficient and low cost alternative to the ambulatory hospitalization patient, with specialized professional equipment optimizing the hospitalization bed/day resource.


REFERENCES

  1. Lown B, Amarasingham R, Newman J. New method for terminating cardiac arrhythmias use of synchronized capacitor discharge. JAMA 1962: 548-55.

  2. Lown B, Kleigher R, Wolff G. The technique of cardioversion. Am Heart J 1964; 67: 282-4.

  3. Dell’Orfano J, Patel H, Wolbrette D, Luck J, Naccarelli G. Acute treatment of atrial fibrillation: spontaneous conversion rates and cost of care.

  4. Fitzmaurice DA. Direct current cardioversion. Br Journal of Gen Prac 2000; 50(460): 919.

  5. Siedl K, Hauer B, Schwick NG, Zellner D, Zahn R, Senges J. Risk of thromboembolic events in patients with atrial flutter. Am J Cardiol 1998; 82: 580-83.

  6. Irani WN, Grayburn PA, Afridi I. Prevalence of thrombus, spontaneous echo contrast, and atrial stunning in patients undergoing cardioversion of atrial flutter. A prospective study using transesophageal echocardiography. Circulation 1997; 95(4): 962-6.

  7. Densem CG. Patients undergoing cardioversion of atrial flutter should be routinely anticoagulated. Am J Cardiol 1999; 83(1): 140-1.

  8. Tobin MG (RN), Pinski SL, Tchou PJ, Ching EA (RN). Cost effectiveness of Administration of Intravenous Anesthetics for Direct-Current Cardioversion by Nonanesthesiologist. Am J Cardiol. 1997; 79: 686-8

  9. Anonymous. Practice guidelines for sedation and analgesia by non-anesthesiologist. A report by the American Society of Anesthesiologist Task Force on sedation and analgesia by non-anesthesiologists. Anesthesiology1996; 84: 459-71.

  10. Goldner BG, et al. Electrical cardioversion of atrial fibrillation or flutter with conscious sedation in the age of cost containment. Am Heart J 1998; 136(6):961-4,

  11. American Nurses association: Position statement of the registered nurses (RN) role in the management of patients receiving I.V. conscious sedation for short-term therapeutic, diagnostic, or surgical procedures. Washington, D.C.: American Nurses Association, 1991.

  12. ACC/AHA/ESC Task Force Report: Guidelines for the management of patients with atrial fibrillation. Eur Heart J 2001; 22: 1852-1923.

  13. Von Gelder IC, Tuinenburg AE, Schoonderwwoerd BS, Tieleman RG, Crijns HJGM. Pharmacologic verus Direct-Current Electrical cardioversion of atrial flutter and fibrillation. Am J Cardiol 1999; 84(9A): 147R-151R.

  14. Thumala A. Fibrilación auricular: por qué, cuándo y cómo tratarla. Rev Méd Chile 1995; 123: 90-7.

  15. Botto GL, Polito A, Bonini W, Broffoni T, Bonatti R. External cardioversion of atrial fibrillation: role of paddle position on technical efficacy and energy requirements. Heart 1999; 82(6): 726-30.

  16. Mittal S, Ayati S, Stein KM, Schwartzman D, Caviovich D, Tchou PJ, Markovitz SM, Slotwiner DJ, Scheiner MA, Lerman BB. Transthoracic cardioversion of atrial fibrillation: comparison of rectilinear biphasic versus damped sine wave monophasic shock. Circulation 2000; 101(11): 1282-7.

  17. Klein AL, Grimm RA, Murray R, Apperson-Hansen C, Asinger RW, Black IW, Davidoff R, Erbel R, Halperin JL, Orsinelli DA, Porter TR, Stoddard MF. Use of transesophageal echocardiography to guide cardioversion in patients with atrial fibrillation. N Engl J Med 2001; 344(19): 1411-20.




2020     |     www.medigraphic.com