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Synchronized cardioversion in a prehospital setting: a safe and reliable method for urgent treatment of tachyarrhythmias


Synchronized cardioversion (SCV) is a useful and reliable method of converting atrial or ventricular tachycardia to sinus rhythm. It is a method of choice in patients who are at high risk of the arrhythmia and therefore require urgent treatment. Conscious patients must be well sedated.

Design and setting

A prospective clinical investigation.

Patients and methods

All adult patients (>18 years) were treated by an emergency physician in the prehospital setting. Indications for SCV were: arrhythmia with severe chest pain and/or shortness of breath, congestive heart failure, pulmonary congestion, decreased level of consciousness (reduced cerebral blood flow), systolic blood pressure less than 90 mmHg, shock, or acute myocardial infarction (AMI). Conscious patients were sedated or anaesthetized with midazolam and morphine, etomidate or propofol.


Over a period of 2 years, 22 patients have required SCV. Indications for SCV included 10 (45.5%) patients with atrial fibrillation (AF) with high risk, seven (31.8%) patients with supraventricular tachycardia (SVT) and five (22.7%) patients with ventricular tachycardia (VT) with pulse. Heart rates in AF and VT were more than 150 beats/min and in SVT more than 200 beats/min. In all patients two or more adverse signs of tachyarrhythmia have been observed: congestive heart failure and/or pulmonary congestion in eight (36.4%) patients, hypotension and/or shock in 15 (68.2%) patients, severe chest pain or AMI in 10 (45.5%) patients; decreased level of consciousness in nine (40.9%) patients. The SCV was successful in all cases (in 19 cases in the first shock with 100 J, in two cases in the second shock with 200 J and in one case in the third shock with 360 J). All patients were hospitalized and left the hospital without any complications.


SCV is a useful and safe method in treatment of unstable tachyarrhythmia in a prehospital setting. This is very important information, because in such situations the universal recommendation of the ILCOR 2000 International Guidelines for immediate cardioversion is the method of choice rather than a trial of antiarrhythmics.

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Jelatancev, A., Grmec, S., Klemen, P. et al. Synchronized cardioversion in a prehospital setting: a safe and reliable method for urgent treatment of tachyarrhythmias. Crit Care 9, P307 (2005).

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  • Atrial Fibrillation
  • Morphine
  • Congestive Heart Failure
  • Cerebral Blood Flow
  • Midazolam