18. Atrial Fibrillation: Electrical Cardioversion and Drug Prophylaxis: 18.2 Sedation with Midazolam for External Cardioversion

Electrical external cardioversion (ECV) is commonly employed in the Electrophysiological Laboratory (EP) to restore sinus rhythm. An Anaesthetist is usually present to assure a general anaesthesia. It is often difficult to obtain the availability of the Anaesthetist during long procedures, such as in atrial fibrillation ablation, when more than one cardioversion is required. We describe our experience for sedation with midazolam for the external cardioversion in absence of an Anaesthetist.

During last 15 months we performed 185 ECV (73 during electrophysiological studies) without anaesthesiology supervision. We excluded patients with serious bronchopulmonary diseases. Midazolam was administered intravenously (4 to 25 mg, mean 10.5 mg). Each patient received high flow oxygen before and after the procedure. Pulse oximetry and cardiac rhythm were monitored during the procedures and subsequent 3 hours.

Midazolam was effective to obtain adequate sedation in all patients. All patients had amnesia in regard to the procedure. No patient required intubation or other emergency manoeuvres.

Sedation with Midazolam for ECV is safe, efficacious and allows for a shorter procedure time in EP laboratory.