Nurse-Led Electrical External Cardioversion of Patients with Atrial Arrhythmia: A Systematic Review Update and Meta-Analysis

Background: Atrial fibrillation, the most frequent and prevalent cardiac arrhythmia, often requires external cardioversion to ensure rhythm control. As healthcare professionals, nurses play a key role in autonomous intervention implementation. The aim was to update current evidence on the efficacy of nurse-led external direct current cardioversion. Methods: A systematic review of primary quantitative studies in English or Italian was conducted with no temporal filter. Seven database searches were interrogated. A total of nine articles were included, for which validity was evaluated and analysed. The review was performed using PRISMA guidelines for systematic reviews. Study characteristics were examined to determine if a meta-analysis was possible, and odds ratio was used as the effect size measure. Results: Data analysis led to the development of selected topics. The success rate of nurse-led direct current cardioversion appears to be high, at >80% (eight out of nine studies) in safe conditions. High-level professional training was required of nurses. There seemed to be no clear consensus on the management of anaesthetic aspects and medical support during the procedure. Meta-analyses of three studies found that there was no risk (M1-OR 0.89, CI [0.58, 1.36]; M2-OR 0.90, CI [0.59, 1.37]) difference between nurse-led DCCV and that performed by other clinicians. Few studies reported data on patient satisfaction, cost effectiveness, and waiting time. Conclusions: This review confirms that nurse-led external direct current cardioversion appears to be successful and safe in restoring sinus rhythm. A high level of nurse training and definition of a shared protocol could allow for effective implementation in more countries and settings.