Internal cardioversion in two patients with atrial fibrillation refractory to external cardioversion

A 26-year-old man underwent an electrophysiological study for evaluation of a history of congenital heart disease, presyncope, and wide complex tachycardia. During the study the patient developed sustained atrial fibrillation with a rapid ventricular response. A 17-year-old man with a history of sick sinus syndrome developed sustained atrial fibrillation. Both patients failed four attempts at external cardioversion with a maximum delivered energy of 360 J. Low energy cardioversion was successful in both patients using biphasic waveforms and internal transvenous defibrillation electrodes. Internal cardioversion using a transvenous electrode system can be successful in patients with atrial fibrillation refractory to external cardioversion.