Performance of Dual Direct-Current Cardioversion

Atrial fibrillation and obesity are common, and both are increasing in prevalence. Obesity is associated with failure of cardioversion of atrial fibrillation using a standard single set of defibrillator pads, even at high output; the optimal cardioversion strategy in patients with obesity is unclear. This study compared the efficacy and safety of dual direct-current cardioversion using 2 sets of pads, with each pair simultaneously delivering 200 J, with traditional single 200-J dual direct-current cardioversion using 1 set of pads. In this video, this procedure is demonstrated in a patient with obesity and atrial fibrillation. The 2 external defibrillator units both reliably synchronized to the QRS complexes, and the 2 shock buttons were depressed simultaneously. This resulted in simultaneous shock delivery.
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