Use of sedation during cardioversion with the implantable atrial defibrillator.

Abstract

The low shock energy used during internal atrial defibrillation may decrease the need for sedation during defibrillation with an implantable atrial defibrillator. The atrial defibrillator (Metrix Atrioverter) was implanted in 12 patients. During the in-hospital treatment of atrial fibrillation (AF) episodes, intravenous sedation was given only on patient request. The Atrioverter was programmed for ambulatory therapy in 4 patients. Efficacy, number of shocks delivered, and sedation requirements were recorded. A total of 393 shocks (1.8+/-1. 6 shocks/AF episode) were delivered to treat 213 AF episodes; 85 of 213 AF episodes (40%) were treated away from the hospital. Sinus rhythm was restored in 195 AF episodes (92%). Five patients never requested sedation. No sedation was needed for ambulatory-treated AF episodes. During the treatment of 26 of 213 AF episodes (12%), 75 shocks were delivered after patients received sedation. The number of shocks required to treat an AF episode determined the need for sedation (4.3+/-2.1 shocks for AF episodes requiring sedation versus 2+/-1 shocks for AF episodes requiring no sedation; P<0.001). These additional shocks were needed to treat immediate reinitiation of AF (14 episodes) or initial failure to cardiovert (4 episodes). For 8 AF episodes, sedation was requested before the first shock. This study suggests that, in a selected group of patients, AF can be treated with Atrioverter therapy without sedation. Successful ambulatory treatment of AF episodes with the Atrioverter, programmed to deliver </=2 shocks, did not require sedation. When multiple shocks were required to treat an AF episode, the need for sedation increased and included patients initially not requesting sedation.