Outpatient cardioversion of XXXX : efficacy, safety, and costs.

@entity1 @entity2917 @entity3126 @entity591 @entity1174 @entity1805 @entity956 @entity955 @entity4710 @entity943 @entity1168
BACKGROUND: Outpatient direct current (DC) cardioversion is performed routinely, yet scant data support this approach. We studied the efficacy, safety, and costs of outpatient cardioversion. METHODS: A retrospective analysis of outpatient cardioversions was performed in a 5-year period at an academic medical center in 532 consecutive outpatients with an @entity4710 . The protocol included anticoagulation (international normalized ratio >or=2.0) for >or=4 consecutive weekly draws and then DC cardioversion with the @entity1 under intravenous anesthesia. @entity943 symptoms, antiarrhythmic therapy use, and costs were evaluated. RESULTS: Ninety percent of @entity1 were discharged in sinus rhythm after cardioversion with a median number of shocks of 1 (range, 1-6) for @entity956 (n = 113), @entity591 (n = 13), and @entity955 (n = 406). Sixty-seven percent of @entity1 were treated with an antiarrhythmic drug. The complication rate was 2.6%, with 11 unplanned admissions. Thromboemboli occurred only in patients whose anticoagulation deviated from protocol and included chronic @entity1805 starting 4 days after cardioversion, transient right-sided weakness, and cerebral vascular accident 3 days after cardioversion, despite negative results on a transesophageal echocardiogram. Two @entity1 had @entity3126 . @entity1168 developed in 4 @entity1 ; transient pacemaker noncapture after the shock occurred in 4 @entity1 . Transient postshock rhythms also included @entity2917 and junctional rhythm. One @entity1 had @entity1174 . The mean cost of cardioversion was 464 dollars. Fees for anesthesia ranged from 525 dollars to 650 dollars. The anesthetic costs ranged from 2.84 dollars to 21.47 dollars. The cardiology fee averaged 501 dollars. CONCLUSION: Outpatient cardioversion is a low risk, effective, and economical procedure.
