Safety of cardiologist-only propofol sedation for elective electrical cardioversion: a retrospective observational study

Aims To evaluate the safety and feasibility of elective electrical cardioversion (ECV) performed under deep sedation with propofol administered exclusively by cardiologists, using predefined clinical criteria in a real-world setting without anesthesiologist involvement. Methods This retrospective single-center study included adult patients who underwent elective ECV for atrial fibrillation or atrial flutter, with intravenous sedation performed using propofol administered exclusively by cardiologists without anesthesiology involvement. Clinical, procedural, and sedation-related data were extracted from electronic health records. Sedation-related adverse events were predefined as follows: hypotension (systolic blood pressure <90 mmHg or requiring fluid/vasopressor support), respiratory depression (oxygen desaturation <90% or need for assisted ventilation), and bradycardia (heart rate <40 bpm or requiring atropine). All events were evaluated according to predefined criteria. Results A total of 80 patients were included. The mean age was 69.4 ± 7.3 years, and 60 patients (75.0%) were male. The mean weight-adjusted propofol dose was 0.81 ± 0.20 mg/kg. The procedural success rate was 91.2%. Sedation-related adverse events occurred in seven patients (8.8%): hypotension in two (2.5%), respiratory depression in one (1.3%), and bradycardia in four (5.0%). All events were mild, self-limiting, and managed without escalation or anesthesiologist intervention. Conclusion Cardiologist led administration of propofol for elective ECV appears safe and feasible. This approach may be particularly useful in healthcare systems with limited access to anesthesiology personnel, supporting a resource efficient model of care.