Fast cardiologist-administered midazolam for electrical cardioversion of atrial fibrillation.

AIM: To evaluate the safety and the feasibility of sedation administered by cardiologists with rapid intravenous bolus of midazolam followed by flumazenil infusion during transthoracic biphasic electrical cardioversion (TEC) for atrial fibrillation (AF). METHODS: Two hundred and sixty-five consecutive patients (119 females, mean age 67.4 +/- 8.5 years) with either acute (24 patients) or persistent AF (mean arrhythmia duration 3.7 +/- 3.0 months) underwent TEC. Midazolam (0.05 mg/kg) was administered as rapid intravenous bolus by the cardiologist, whereas the anaesthesiologist was simply alerted. At the end of the procedure, intravenous flumazenil 0.25 mg was given, followed by 0.25 mg over 1 h. Patients received continuous electrocardiographic and pulse-oxymetric monitoring. RESULTS: Adequate sedation was obtained in 262 patients (98.9%), with a mean midazolam dose of 4.4 +/- 0.9 mg. After drug administration, the mean time to patient's sedation and reawakening were 3.1 +/- 1.9 and 6.1 +/- 2.7 min, respectively. The mean reduction in oxygen saturation was 5.4 +/- 3.7%. Sinus rhythm was restored in 254 patients (95.8%). All but 41 patients (15.5%) were completely amnesic. None reported pain. No adverse events were registered. No urgent call for the anaesthesiologist was made. CONCLUSIONS: Conscious sedation with fast-administered midazolam followed by flumazenil for cardioversion of atrial fibrillation is safe, effective and well tolerated, easing the procedure and shortening its duration.

Safety and feasibility of coronary sinus left ventricular leads extraction: a preliminary report.

BACKGROUND: transvenous positioning of the left ventricular (LV) lead in a branch of the coronary sinus (CS) is generally the preferred implantation technique in biventricular pacing. Very few data are reported about removal of LV pacing leads positioned in a CS branch. Aim of the study was to describe our experience with percutaneous extraction of LV pacing leads in order to evaluate feasibility and safety of this procedure. METHODS: we enrolled 392 patients who underwent a biventricular pacing implant. The indication for catheter removal was considered in case of definite diagnosis of infection and in some cases of lead dislodgement or diaphragmatic stimulation. LV lead extraction was first attempted by manual traction; in case of failure a locking stylet or locking stylet plus radiofrequency could be used. RESULTS: twelve of 392 patients implanted needed LV lead removal. The leads had been in place for 13.9 +/- 11.7 months. Extraction was indicated in 5 of them for LV lead dislodgement or diaphragmatic stimulation, and in 7 patients for lead infection. In all cases manual traction succeeded to remove the LV lead. In 7 cases of infection, the right atrial and ventricular leads were removed. The mean total procedure time was 69 +/- 22 min. No complications were observed. CONCLUSIONS: our study suggests that CS leads could be easily and safely removed without any complication, also when placed in a CS branch, at least for relatively young catheters.