CONGRESS ABSTRACT

Worldwide, atrial fibrillation is the most common sustained cardiac arrhythmia in adults. Electrical cardioversion is still the preferred method to restore sinus rhythm in patients with atrial fibrillation. The main, and probably the only, disadvantage of electrical cardioversion is that it requires deep sedation with anesthetics. The most widely used anesthetic for this type of procedure is Propofol, due to its pharmacodynamic and pharmacokinetic properties with administration that is generally performed by anesthesiologists. The aim of this study was to evaluate the feasibility and safety of deep sedation for elective elettric cardioversion with only propofol by the cardiologist with a shared protocol with anesthesiologists. The proposed protocol involves using Propofol according to current local anesthetic practices (0.5-1 mg/kg) and recording all procedures and any complications. The protocol included operational training with anesthesiological assistance with the procedure performed entirely by the cardiologist with sharing of the dosage of the drug and preparation for sedation with the intervention of the anesthesiologist only in case of complications In the case of multiple and severe comorbidities (obesity, respiratory failure, OSAS, etc.) the patient could be excluded from this protocol The data of the 40 electrical cardioversions (38 patients) performed in the year 2024 were prospectively analyzed. 1 patient was excluded for consuming alcohol the previous evening. Electrical cardioversion was effective in 98.9% of the cases. Deep sedation was effective in 100% of cases with a medium dosage of propofol of 76 mg, with a minimum of 50 and a maximun of 140 mg. No deep sedation -related complications were observed, neither significant respiratory depression requiring intubation nor anaesthesiologist support. All patients showed rapid recovery by waking up within minutes, on 3 occasions non-invasive supportive ventilation was required. No thromboembolic and allergic complications were observed. Arrhythmic complications were bradyarrhythmias especially sinus bradycardia (6 patients), a 3-second pause was recorded in one patient. No hypotension has been reported. In conlusion deep sedation with Propofol alone for electrical cardioversion electron procedures in patients with atrial fibrillation can be safely managed by a cardiologist.