Initial energy for electrical cardioversion of atrial fibrillation - Is more better?

Techniques for electrical cardioversion of atrial fibrillation do not have a robust scientific base in the context of the current management strategie s for this tachyarrhythmia. Joglar et al present experiments in the current issue showing superiority of higher first-shock energy for electrical card ioversion of atrial fibrillation that has been present for >48 hours, confi rming the experience of many cardiologists; this is not likely the last wor d in an evolving area.