Double-dose external cardioversion for refractory unstable atrial fibrillation in the ED

Am J Emerg Med. 2008 Mar;26(3):385.e1-3. doi: 10.1016/j.ajem.2007.07.024.


A 45-year-old man with dilated cardiomyopathy, atrial fibrillation, and hypertension presented to the emergency department with palpitations and shortness of breath for 2 days after running out of his medications. An electrocardiogram disclosed atrial fibrillation with rapid ventricular response. The patient was hemodynamically unstable and failed multiple cardioversion attempts up to 360 J. A second defibrillator was then attached and the patient successfully cardioverted once both defibrillators were set to their maximum levels, thus delivering a total of 720 J. Double-dose external cardioversion with 2 defibrillators is an important alternative method that the emergency physician should be aware of when treating refractory atrial fibrillation in the hemodynamically unstable patient.

Publication types

  • Case Reports

MeSH terms

  • Atrial Fibrillation / therapy*
  • Electric Countershock / methods*
  • Electrocardiography
  • Emergency Service, Hospital
  • Humans
  • Male
  • Middle Aged