Modified dual direct-current cardioversion as a bailout strategy in patients with atrial arrhythmia resistant to standard-of-care therapy

Direct-current electrical cardioversion (DCCV) remains a standard of care for restoring sinus rhythm (SR) in patients with atrial fibrillation (AF), with a high reported success rate of approximately 87% (regardless of electrodes position: anterior-posterior versus anteriorlateral) [1], which can be further increased by antiarrhythmic drugs pre-treatment [2].However, some patients remain resistant to such therapy and might require a more tailored approach [3].Recently, a further modification of the standard technique has been proposed, where a