SCOPE OF THE PROBLEM

The first use of electricity in resuscitation was described in 1774 by the Royal Humane Society in London for a near-drowned child. In the late nineteenth century, treatment of ventricular fibrillation was described in animals with the use of electricity. In 1947, successful termination of ventricular fibrillation was described using AC current in humans. In the 1960s, direct current cardioversion was described and this ultimately became the standard for modern-day cardioversion. Cardioversion techniques have been modified and developed during the past 50 years with different waveforms, amplitudes, and timing for delivering safe and effective cardioversion.

The ideal agents and methods to provide procedural sedation and analgesia (PSA) during the cardioversion procedure have been less well investigated. Few studies have evaluated the use of PSA in the emergency department (ED) for electrical cardioversion. Additionally, studies that have addressed this unique problem in the ED setting have been limited by small sample sizes. As a consequence, there is a large variation of clinical practice for PSA during ED cardioversion.

Despite a lack of a uniform approach to PSA during ED cardioversion, it is clear that electrical cardioversion as an ED-based procedure is becoming more commonplace. This is largely due to an aging population with elevated risk for arrhythmias.

The largest cohort of ED patients with stable arrhythmias that are candidates for cardioversion is the new-onset atrial fibrillation and flutter group. Atrial fibrillation is the most common arrhythmia seen in the ED and afflicts approximately 0.4% of the population.