Naomi Lollback
Princess Alexandra Hospital, Australia
Title: Specialist nurse led external cardioversion service at a tertiary cardiac center: A safe pair of hands?
Biography
Biography: Naomi Lollback
Abstract
Introduction: External DC cardioversion (EDCCV) is standard procedure for treatment of tachyarrhythmias. Objective: A review of an outpatient-based cardioversion service led by a cardiac trained electrophysiology and pacing nurse consultant (CNC). Methods: A review of patients (pts) referred from the general hospital population was undertaken from 2006-2015. Patients were included only if they had adequate, continuous anticoagulation monitored by the CNC in the 3 weeks prior to EDCCV and reviewed in a preadmission clinic where informed consent was obtained by a junior cardiology registrar. The CNC directed all procedures as day cases in a high dependency cardiac monitoring unit in the presence of an anaesthetist and a trainee cardiology registrar. A consultant cardiologist attended patients with a pacemaker or defibrillator. Results: EDCCV was performed in 729 patients, 74% males, median age 65 yrs (range 23-95) in whom 73% had atrial fibrillation and 27% atrial flutter. Biphasic external shock, range 50-200J, was applied with an anterior posterior vector. The mean shock energy was 155J with a mean number 1.35+0.16 (range 1-4) per patient. The success rate was 89%. Patients were usually discharged within 4 hours but 13 required admission: 1 asystole requiring external pacing, 5 admitted for sinus bradycardia, 1 for bronchospasm and hypotension, and 5 for temporary heart block needing monitoring. One patient suffered a CVA 12 hours post procedure. There were no deaths or other serious morbidity. Conclusion: An EDCCV service run by a trained experienced electrophysiology nurse in a monitored environment is safe and effective.