Pulmonary Edema following Direct Current Cardioversion

¹ Instructor of Medicine, University of Utah College of Medicine, and Research and Education Associate, Veterans Administration Hospital, Salt Lake City, Utah
² Assistant Professor of Medicine, University of Utah College of Medicine, and Chief Cardiology Division, Veterans Administration Hospital, Salt Lake City, Utah

The most common complications of direct current (DC) shock for the treatment of cardiac arrhythmias are arrhythmias and embolic episodes. Pulmonary edema, a poorly understood complication of DC shock, has been reported in eight patients following reversion from atrial fibrillation to sinus rhythm. This report describes a 32-year-old white man with cardiomyopathy of unknown etiology who experienced pulmonary edema on two separate occasions seven months apart following DC cardieversion despite significant slowing of the ventricular rate. To our knowledge, this is the first reported case in which pulmonary edema occurred more than once following reversion to sinus rhythm. Although the mechanism of pulmonary edema in this and the other reported cases is unknown, some workers have suggested that the mechanism is related to the reversion to sinus rhythm.