The introduction of a new service for direct current cardioversion (DCCV) for atrial fibrillation in a district general hospital

The timing and effectiveness of a new protocol for organising direct current cardioversion (DCCV) for patients with atrial fibrillation (AF) was compared with the existing system in a medium-sized district general hospital in the United Kingdom. The new protocol comprised a monthly dedicated DCCV list in the operating theatres, with an anaesthetist and an Operating Department Assistant providing anaesthesia, and cardiology medical staff performing the cardioversion. The last 35 consecutive patients undergoing DCCV for AF before the new protocol was introduced were compared with the first 35 patients having DCCV under the new protocol.
The time to perform 35 consecutive cardioversions was reduced from 32 months to 10 months. The new system resulted in no cancellations for administrative reasons and only one patient for a clinical reason. Sinus rhythm (SR) was restored in 60% cases under the new protocol (double the success rate before the new protocol) and 76% patients discharged in SR under the new protocol, remained in SR at clinic follow-up.
A simple change in the method of delivering a clinical service has resulted in an improvement in both the administration and clinical outcome for patients. Such changes, requiring co-operation between anaesthetic and cardiology departments, could be implemented widely for the benefit of many patients.