33893
document
Transthoracic versus transesophageal cardioversion of atrial fibrillation under light sedation : a prospective randomized trial . BACKGROUND Electrical cardioversion ( ECV ) of atrial fibrillation ( AF ) is limited by a 5-10 % failure rate and by the expense arising from a perceived need for general anesthesia . A transesophageal approach using light sedation has been proposed as a means of augmenting the success rate and avoiding the need for general anesthesia . We hypothesized that the high rate of success and the lower energy requirement associated with biphasic cardioversion might eliminate any advantage of the transesophageal approach . METHODS We randomly assigned 60 patients attending for ECV of persistent AF to a transesophageal or a transthoracic approach . Sedation of moderate depth was achieved with intravenous midazolam . The dose of midazolam was titrated in the same manner in both groups . RESULTS Sinus rhythm was restored in 29/30 patients ( 97 % ) in each group using a similar number of shocks for both groups ( 1.3 +/- 0.6 transesophageal vs 1.4 +/- 0.7 transthoracic , P = NS ) with a similar procedure duration ( 14.1 +/- 8.2 minutes vs 13.8 +/- 7.5 minutes , P = NS ) . Both groups received similar doses of midazolam ( 4.2 +/- 2.7 mg vs 4.4 +/- 2.8 mg , P = NS ) and both reported a similar discomfort score in ( 0.9 +/- 1.3 vs 1.1 +/- 1.8 , P = NS ) . No complication occurred in either group . CONCLUSION AF may be cardioverted safely and effectively by either a transthoracic or a transesophageal approach . The use of sedation of moderate depth renders cardioversion by either approach acceptable . As transesophageal ECV shows no clear advantage , transthoracic cardioversion should remain the approach of first choice .
33894
Intervention_Physical
Transthoracic
33895
Intervention_Surgical
transesophageal cardioversion
33896
Intervention_Surgical
transesophageal
33897
Intervention_Physical
transthoracic approach
33898
Intervention_Pharmacological
intravenous midazolam
33899
Outcome_Physical
Sinus rhythm
33900
Outcome_Pain
discomfort score
33901
Outcome_Adverse-effects
complication
33902
Outcome_Other
safely and effectively