title: Double-dose external cardioversion for refractory unstable atrial fibrillation in the ED.
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.
authors: Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA. achang@montefiore.org
authors: Andrew K
authors: AK
authors: Chang
authors: Gretchen S
authors: GS
authors: Lent
authors: Diana
authors: D
authors: Grinberg
mesh_terms: D001281:Atrial Fibrillation / Q000628:therapy*; D004554:Electric Countershock / Q000379:methods*; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D006801:Humans; D008297:Male; D008875:Middle Aged