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  • Title: Double-dose external cardioversion for refractory unstable atrial fibrillation in the ED.
    Author: Chang AK, Lent GS, Grinberg D.
    Journal: Am J Emerg Med; 2008 Mar; 26(3):385.e1-3. PubMed ID: 18358976.
    Abstract:
    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.
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