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March 20, 1967

Direct-Current Countershock Without Anesthesia: Experience in a Military Hospital in the Management of Arrhythmias

Author Affiliations


From the Department of Medicine, US Army General Hospital, Landstuhl, Germany. Dr. Farfel is now with the George Washington University School of Medicine and the Washington Hospital Center, Washington, DC.

JAMA. 1967;199(12):939-941. doi:10.1001/jama.1967.03120120127032

IN 1962, Lown, Amarasingham, and Neuman1 introduced synchronized direct-current capacitance discharge in the management of cardiac arrhythmias. The efficacy of cardioversion has been clearly demonstrated. An initial limitation of the method was the requirement of general anesthesia. Stock2 first suggested that in view of the brief duration of the shock (2.5 msec), cardioversion could be done safely without undue discomfort in the absence of anesthesia.

The purpose of this communication is to present experience with electrical countershock, at the US Army General Hospital, Landstuhl, Germany, between May 1965 and May 1966, and in particular, its use without anesthesia.

Methods  The Lown "Cardioverter"3 was used. Patients were selected for elective conversion only if clinical evaluation suggested it would be beneficial and there was a good probability of maintaining sinus rhythm once reverted. Each patient had had at least one previous attempt at reversion by pharmacological means.Treatment with