Introduction/Hypothesis
Direct current cardioversion is used to treat atrial fibrillation and atrial flutter. Propofol is commonly used for sedation during electric cardioversion requiring the presence of an anesthesiologist. In contrast, the use of midazolam allows cardioversion without the presence of an anesthesiologist. Patient experience using the different sedation methods during direct cardioversion is largely unknown. The aim of this study is to investigate patient experience of direct cardioversion with sedation using either intravenous propofol or intravenous midazolam.

Methods
The study was designed as a prospective cohort study and conducted at Randers Regional Hospital, Denmark. Patients undergoing both elective and acute direct current cardioversion were included. Data was collected using a post-cardioversion questionnaire. The primary endpoint was perceived pain after cardioversion on a numeric rating scale (NRS) from 1 (best) to 10 (worst). As pain is a subjective unpleasant sensation, all patients were inquired about experienced pain (NRS: 1-10) from intravenous cannulation. Secondary endpoints included patient recall of shock delivery, feeling of safety, and patient-reported overall experience of the procedure.

Results
In total, 110 patients were included in the study (60 propofol, 50 midazolam). Baseline characteristics were similar, while the amount of acute cardioversion was greater in the midazolam group. The perceived pain after cardioversion was not different (median(IQR); propofol 1(1;1), midazolam 1(1;1), p=0.18). Similar the perceived pain from intravenous cannulation was not different (median(IQR); propofol 2(1;3), midazolam 2(1;3), p=0.47). The feeling of safety was not different between groups and there was no recall of shock. The patient-reported overall experience of cardioversion was good (median NRS: 1, 1 best, 10 worst) regardless of sedation.

Conclusion
In patients undergoing direct current cardioversion, clinical and patient-reported outcomes were not significantly different when sedation was performed with propofol or midazolam. Notably, perceived pain following cardioversion was less compared to intravenous cannulation. Cardioversion with midazolam can be performed without an anesthesiologist present and may be preferred over propofol.

**Introduction/Hypothesis**
Direct current cardioversion is used to treat atrial fibrillation and atrial flutter. Propofol is commonly used for sedation during electric cardioversion requiring the presence of an anesthesiologist. In contrast, the use of midazolam allows cardioversion without the presence of an anesthesiologist. Patient experience using the different sedation methods during direct cardioversion is largely unknown. The aim of this study is to investigate patient experience of direct cardioversion with sedation using either intravenous propofol or intravenous midazolam.

**Methods**
The study was designed as a prospective cohort study and conducted at Randers Regional Hospital, Denmark. Patients undergoing both elective and acute direct current cardioversion were included. Data was collected using a post-cardioversion questionnaire. The primary endpoint was perceived pain after cardioversion on a numeric rating scale (NRS) from 1 (best) to 10 (worst). As pain is a subjective unpleasant sensation, all patients were inquired about experienced pain (NRS: 1-10) from intravenous cannulation. Secondary endpoints included patient recall of shock delivery, feeling of safety, and patient-reported overall experience of the procedure.

**Results**
In total, 110 patients were included in the study (60 propofol, 50 midazolam). Baseline characteristics were similar, while the amount of acute cardioversion was greater in the midazolam group. The perceived pain after cardioversion was not different (median(IQR); propofol 1(1;1), midazolam 1(1;1), p=0.18). Similar the perceived pain from intravenous cannulation was not different (median(IQR); propofol 2(1;3), midazolam 2(1;3), p=0.47). The feeling of safety was not different between groups and there was no recall of shock. The patient-reported overall experience of cardioversion was good (median NRS: 1, 1 best, 10 worst) regardless of sedation.

**Conclusion**
In patients undergoing direct current cardioversion, clinical and patient-reported outcomes were not significantly different when sedation was performed with propofol or midazolam. Notably, perceived pain following cardioversion was less compared to intravenous cannulation. Cardioversion with midazolam can be performed without an anesthesiologist present and may be preferred over propofol.

Patient experience of electrical cardioversion using sedation by propofol or midazolam: A cohort study