Cardioversion of obese patients: what is the weight of evidence?

As eager medical residents at a busy heart hospital, the opportunity to participate in the drama of cardiac resuscitation was abundant. Our population's demographic translated into a high percentage of morbidly obese among the unfortunate souls who needed our emergent ministration. So it was fairly early in my (PRK) career that I began to reflect on the adequacy of the methods we have traditionally used to cardiovert and defibrillate patients in whom the heart was distant from our paddles, functionally insulated from the electrical energy meant to reverse their arrhythmias and, in some cases, to save their lives.