title: Improving the acceptability of the atrial defibrillator for the treatment of persistent atrial fibrillation: the atrial defibrillator sedation assessment study (ADSAS).
abstract: BACKGROUND
  To compare the acceptability and effectiveness of three pre-medication regimens for manually activated cardioversion of recurrent persistent atrial fibrillation.
  
  
  METHODS
  Eighteen patients implanted with the Jewel AF atrial defibrillator for drug-resistant persistent atrial fibrillation only were studied in an open-labelled randomised crossover study. Patients were assigned to sedation (S) with midazolam elixir, analgesia (A) with morphine sulphate or combination therapy (C) with dextromoramide and lorazepam. Pre-medication was taken up to 1 h before cardioversion. Patients rotated through each type of medication after undertaking at least one cardioversion. Visual analogue scales were completed immediately post-cardioversion and 24 h later for pain, anxiety and 'unpleasantness'. Higher scores represented a worse outcome.
  
  
  RESULTS
  After 2 years' follow-up, 238 cardioversions were performed with S, 17 with A and 35 with C. The mean immediate combined score for S (10.9, 95% confidence interval (CI) 8.2-13.6) was significantly lower than for A (17.3, 95% CI 15.1-19.5, P = 0.01) and for C (15.9, 95% CI 12.3-19.6, P = 0.02). All patients who used S chose it as the most favourable pre-medicant. All patients who used A found it the least acceptable.
  
  
  CONCLUSIONS
  Sedation rather than analgesia enhanced the acceptability of manually activated atrial defibrillation.
authors.affiliation: Department of Cardiology, Eastbourne General Hospital, Kings Drive, Eastbourne BN21 2UD, UK. mitcharj@doctors.org.uk
authors.forename: Andrew R J
authors.initials: AR
authors.lastname: Mitchell
authors.forename: Philip A R
authors.initials: PA
authors.lastname: Spurrell
authors.forename: Bart E W
authors.initials: BE
authors.lastname: Gerritse
authors.forename: Neil
authors.initials: N
authors.lastname: Sulke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000628:therapy*; D002908:Chronic Disease; D016001:Confidence Intervals; D016292:Procedural Sedation / Q000379:methods; D018592:Cross-Over Studies; D003501:Cyclizine / Q000008:administration & dosage; D017147:Defibrillators, Implantable; D003916:Dextromoramide / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008140:Lorazepam / Q000008:administration & dosage; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D010147:Pain Measurement; D010342:Patient Acceptance of Health Care; D011292:Premedication; D011336:Probability; D012016:Reference Values; D018570:Risk Assessment; D016037:Single-Blind Method; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D009020:Morphine; D003916:Dextromoramide; D008140:Lorazepam; D003501:Cyclizine; D008874:Midazolam