Hostname: page-component-848d4c4894-hfldf Total loading time: 0 Render date: 2024-05-18T16:12:02.221Z Has data issue: false hasContentIssue false
  • English
  • Français

Prehospital Synchronized Electrical Cardioversion of a Poorly Perfused SVT Patient by Paramedics

Published online by Cambridge University Press:  14 March 2013

Gavin Smith ,
David McD Taylor ,
Amee Morgans  and
Peter Cameron
Gavin Smith*
Affiliation:
Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
David McD Taylor
Affiliation:
Austin Health, Heidelberg, Victoria, Australia
Amee Morgans
Affiliation:
Ambulance Victoria, Doncaster, Victoria, Australia
Peter Cameron
Affiliation:
Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
*
Correspondence: Gavin Smith, B. Para. Studies, Grad. Dip. Emerg. Health, MEH, PhD(c) Department of Epidemiology and Preventative Medicine Faculty of Medicine, Nursing, and Health Sciences Monash University Alfred Centre, 99 Commercial Road Melbourne, Australia E-mail gavin.smith@monash.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Synchronized Direct Current Cardioversion (SDC) is an established therapy for the termination of supraventricular tachycardia (SVT – either atrio-ventricular nodal reentry tachycardia (AVNRT) or atrio-ventricular reentrant tachycardia (AVRT)) with poor perfusion. The evidence is extremely limited with regard to the safety and effectiveness of this therapy. In Australia, half of the eight ambulance services include SDC within their clinical practice guidelines for the management of poorly perfused SVT; however the degree of variation in the application of SDC across these guidelines suggests a need to quantify the practice. This case provides a previously unreported example of the safety and effectiveness of prehospital SDC for SVT (with poor perfusion precipitated by a Valsalva Maneuver) by Victorian paramedics, and discusses the available literature regarding the effectiveness and safety of this practice.

SmithG, TaylorD, MorgansA, CameronP. Prehospital Synchronized Electrical Cardioversion of a Poorly Perfused SVT Patient by Paramedics. Prehosp Disaster Med. 2013;28(3):1-4.

Keywords

prehospitalsupraventricular tachycardiasynchronized direct current electrical cardioverson
Type
Case Report
Information
Prehospital and Disaster Medicine , Volume 28 , Issue 3 , June 2013 , pp. 301 - 304
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Botto, GL, Politi, A, Bonini, W, Broffini, T, Bonatti, R. External cardioversion of atrial fibrillation: role of paddle position on technical efficacy and energy requirements. Heart. 1999;82(6):726-730.CrossRefGoogle ScholarPubMed
2.Kirchhof, P, Eckhardt, L, Loh, P, Weber, K, Fischer, R-J, Seidl, K-H, et al. Anterior-posterior versus anterior-lateral electrode positions for external cardioversion of atrial fibrillation: a randomised trial. Lancet. 2002;360:1275-1279.CrossRefGoogle ScholarPubMed
3.Mathew, TP, Moore, A, McIntyre, M, Harbinson, MT, Campbell, NPS, Adgey, AAJ, et al. Randomised comparison of electrode positions for cardioversion of atrial fibrillation. Heart. 1999;81:576-579.CrossRefGoogle ScholarPubMed
4.Boodhoo, L, Bordoli, G, Mitchell, AR, Lloyd, G, Sulke, N, Patel, N. The safety and effectiveness of a nurse led cardioversion service under sedation. Heart. 2004;90:1443-1446.CrossRefGoogle ScholarPubMed
5.Lown, B, Kleiger, R, Wolff, G. The technique of cardioversion. Am Heart J. 1964:282-284.CrossRefGoogle ScholarPubMed
6.Pantridge, JF, Halmos, PB. Conversion of atrial fibrillation by direct current counter shock. Br Heart J. 1965;27:128-131.CrossRefGoogle ScholarPubMed
7.Sinclair-Smith, BC. Electrical reversion of cardiac arrhythmias. South Med J. 1972;65(3):289-293.CrossRefGoogle ScholarPubMed
8.Mortensen, K, Risius, T, Schwemer, TF, Aydin, MA, Koster, R, Klemm, HU, et al. Biphasic versus monophasic shock for extrenal cardioversion of atrial flutter. Cardiology. 2008;111:57-62.CrossRefGoogle Scholar
9.Pinski, SL, Sgarbossa, EB, Ching, E, Trohman, RG. A comparison of 50-J versus 100-J shocks for direct-current cardioversion of atrial flutter. Am Heart J. 1999;137:439-442.CrossRefGoogle ScholarPubMed
10.Skulec, R, Belohlavek, J, Kovarnik, T, Kolar, J, Gandalovicova, J, Dytrych, V, et al. Serum cardiac markers response to biphasic and monophasic electrical cardioversion for supraventricular tachyarrhythmia - a randomised study. Resuscitation. 2006;70:423-431.CrossRefGoogle ScholarPubMed
11.Sucu, M, Davutoglu, V, Ozer, O. Electrical cardioversion. Ann Saudi Med. 2009;29(3):201-206.CrossRefGoogle ScholarPubMed
12. Anon. CPG A0403: Supraventricular Tachycardias. Ambulance Victoria Clinical Practice Guidelines. Government Publishers 2009 (September 2009).Google Scholar
13.Mayr, A, Ritsch, N, Knotzer, H, Dunser, M, Schobersberger, W, Ulmer, H, et al. Effectiveness of direct-current cardioversion for treatment of supraventricular tachyarrhythmias, in particular atrial fibrillation, in surgical intensive care patients. Crit Care Med. 2003;31(2):401-405.CrossRefGoogle ScholarPubMed
14.Roth, A, Elkayam, I, Shapira, I, Sander, J, Malov, N, HKehati, M, et al. Effectiveness of pre-hospital synchronous direct-current cardioversion for supraventricular tachyarrhythmias causing unstable hemodynaic states. Am J Cardiol. 2003;91:489-491.CrossRefGoogle Scholar
15.Van Der Watt, MJ, Aboo, AA, Scott Millar, RN. A prospective study of electrical cardioversion for sustained tachycardias by emergency unit personnel. S Afr Med J. 1995;85(6):508-511.Google ScholarPubMed
16.Boodhoo, L, Bordoli, G, Mitchell, AR, Lloyd, G, Sulke, N, Patel, N. The safety and effectiveness of a nurse led cardioversion service under sedation. Heart. 2004;90:1443-1446.CrossRefGoogle ScholarPubMed
17.Botkin, SB, Dhanekula, LS, Olshansky, B. Outpatient cardioversion of atrial arrhythmias: efficacy, safety and costs. Am Heart J. 2003;145(2):233-238.CrossRefGoogle ScholarPubMed
18. Anon. Dysrhythmias - Tachycardia. Ambulance Service New South Wales Clinical Guidelines. Government Publishers; 2011.Google Scholar
19. Anon. CPG A0403: Supraventricular Tachyarrhythmias. Ambulance Victoria Clinical Practice Guidelines. Government Publishers; 2009.Google Scholar
20. Anon. Supraventricular Tachycardia. South Australian Ambulance Service Clinical Practice Guidelines. Government Publishers; 2009.Google Scholar
21. Anon. Narrow Complex Tachycardia. Queensland Ambulance Service Clinical Practice Manual. Government Publishers; 2011.Google Scholar
22. Anon. Guideline 8: Tachycardias. ACT Ambulance Clinical Management Guidelines. Government Publishers; 2010.Google Scholar