title: Electrical cardioversion of atrial fibrillation or flutter with conscious sedation in the age of cost containment.
abstract: BACKGROUND
  The purpose of this study was to compare the safety, efficacy, and cost of conscious sedation administered by electrophysiologists certified in the use of conscious sedation with sedation administered by anesthesiologists during cardioversion of atrial fibrillation or atrial flutter to sinus rhythm.
  
  
  RESULTS
  Patients with hemodynamically stable persistent atrial fibrillation and flutter were included in this study. Group 1 patients (n = 33) were sedated by an anesthesiologist and group 2 patients (n = 26) were sedated by an electrophysiologist. Anesthesiologists used propofol and electrophysiologists used midazolam and morphine for sedation. A cost analysis based on professional charges and cost of medications was performed for both groups and compared. Hospital charges were similar for both groups and were excluded from the cost analysis. Although time to sedation in group 1 was shorter than that in group 2, sedation was adequate in both groups such that no patient in group 1 and only 1 patient in group 2 recalled being shocked. There were no complications in either group. The cost incurred in group 2 was less than that in group 1.
  
  
  CONCLUSIONS
  Sedation administered by electrophysiologists for cardioversion of atrial arrhythmias is safe and cost effective. Midazolam and morphine, the sedative agents administered by electrophysiologists, were effective and well tolerated by patients.
authors.affiliation: Electrophysiology Section, Department of Medicine, North Shore University Hospital, Manhasset, NY, USA.
authors.forename: B G
authors.initials: BG
authors.lastname: Goldner
authors.forename: J
authors.initials: J
authors.lastname: Baker
authors.forename: A
authors.initials: A
authors.lastname: Accordino
authors.forename: L
authors.initials: L
authors.lastname: Sabatino
authors.forename: M
authors.initials: M
authors.lastname: DiGiulio
authors.forename: D
authors.initials: D
authors.lastname: Kalenderian
authors.forename: D
authors.initials: D
authors.lastname: Lin
authors.forename: V
authors.initials: V
authors.lastname: Zambrotta
authors.forename: J
authors.initials: J
authors.lastname: Stechel
authors.forename: P
authors.initials: P
authors.lastname: Maccaro
authors.forename: R
authors.initials: R
authors.lastname: Jadonath
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid; D000761:Anesthesia Department, Hospital / Q000191:economics* / Q000592:standards; D000776:Anesthesiology; D018686:Anesthetics, Intravenous; D001281:Atrial Fibrillation / Q000191:economics / Q000628:therapy*; D001282:Atrial Flutter / Q000191:economics / Q000628:therapy*; D016292:Procedural Sedation / Q000191:economics* / Q000379:methods; D003363:Cost Control; D004554:Electric Countershock; D004594:Electrophysiology; D005260:Female; D017722:Hospital Charges; D006801:Humans; D008297:Male; D008874:Midazolam; D008875:Middle Aged; D009518:New York; D015742:Propofol
chemical_list: D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D008874:Midazolam; D015742:Propofol