Background: Direct Current Cardioversion (DCCV) has traditionally been performed by physicians in the United States. Publications from the United Kingdom have suggested that a specialist nurse led DCCV of atrial fibrillation and atrial flutter was feasible. This practice has not been reported in the United States previously. Several years ago, we introduced a DCCV program utilizing advanced practice providers, (physician assistants or nurse practitioners) with special training in cardiology, to perform elective DCCV in patients with atrial fibrillation and atrial flutter under general anesthesia, without direct physician supervision.
Methods: Upon receiving approval from the institutional review board, we conducted a retrospective analysis of 497 patients undergoing an elective DCCV procedure for atrial fibrillation or atrial flutter at Regions Hospital between 12/16/2006 and 10/11/2010. The cohort was divided into two groups depending on whether DCCV was performed by an advanced practice provider or a cardiologist. Procedural success rates (conversion to sinus rhythm) and procedural related complications were compared between the two groups using Fischer's Exact Test.
Results: Elective DCCV was performed by advanced practice providers in 447 patients and by a cardiologist in 50 patients. Procedural success rates were 92% (412/447) for advanced practice providers and 88% (44/50) for cardiologists. This difference was statistically insignificant (p = 0.28). Procedural complication rates were 1.3% (6/447) for advanced practice providers and 0% (0/50) for cardiologists. This difference was also statistically insignificant (p = 1.00).
Conclusion: Under general anesthesia, elective DCCV of atrial fibrillation and atrial flutter performed by advanced practice providers, without direct physician supervision, is effective and does not compromise safety.