Shelton Rhidian J, Allinson Alan, Johnson Tracey, Smales Charles, Kaye Gerald C
Department of Cardiology, Castle Hill Hospital Cottingham, Kingston-upon-Hull HU16 5JQ, UK.
Europace. 2006 Jan;8(1):81-5. doi: 10.1093/europace/euj009.
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.
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.
The provision of a nurse-led elective cardioversion service is feasible and effective, without compromising safety.
体外直流电复律是恢复持续性房性心律失常患者窦性心律（SR）的有效方法。医院床位需求的增加，以及初级医生工作时间的减少，对复律治疗产生了不利影响。为解决这些限制因素，在一家专门的医院日间病房引入了由护士定期主导的复律服务。关于这种服务的安全性或有效性的数据有限。
2000年10月至2004年10月期间的所有复律均由经过适当培训的专科护士在全身麻醉下进行。患者前往预评估诊所就诊。初始及后续除颤的能量需求遵循当地方案，并参照美国心脏协会、美国心脏病学会和欧洲心脏病学会的指南。2004年1月引入直线双相除颤，并对方案进行了适当修订。在无并发症的情况下，目标是让患者在当天出院。共对464例患者（男性占72.1%，平均年龄67.8±9.4岁）进行了578次复律（475次单相；103次双相），其中房颤（AF）患者占89.7%（416例），房扑患者占10.3%（48例）。房颤和房扑患者恢复窦性心律的比例分别为84.0%和100%，引入双相除颤后分别增至90.2%和100%。与单相除颤相比，双相电击复律房颤所需能量更低（163±22 J对289±81 J），累积能量更少（230±139 J对455±255 J）（两者P均<0.001），尽管房颤持续时间（P = 0.26）或患者年龄（P = 0.78）无差异。2例患者因短暂性心动过缓需住院治疗；两人均在72小时内出院，无需永久性起搏。共有99.6%的患者在当天出院回家；无死亡病例。
提供由护士主导的择期复律服务是可行且有效的，且不影响安全性。
