Abstract
Three patients developed acute pulmonary edema shortly after direct current cardioversion for atrail arrhythmias. All patients had marked left ventricular enlargement and evidence of left ventricular failure prior to cardioversion. Each patient received a single low-intensity shock. Two patients recovered, but the third failed to respond to intensive medical treatment for pulmonary edema, and death resulted. Cardioversion may result in critical depression of left ventricular function and may not be indicated for the treatment of atrial arrhythmias in the presence of severe disease of the left ventricle.
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