CASE PRESENTATION: A 55 year-old caucasian male with left ventricular systolic dysfunction, diabetes mellitus, paroxysmal AFib, and morbid obesity (BMI 50.1) was admitted for AFib. During an elective TEE cardioversion, the patient went into VF. CPR was initiated per ACLS protocol and biphasic defib was attempted at 300J, with failure to convert to NSR. Two minutes later, a second defib shock at 360J was delivered along with IV amiodarone, however this too failed to convert VF. After two more minutes, IV lidocaine and a third 360J defib shock was administered; again failing to convert VF. The decision was made to attempt DSD. Using defib pads from defib #1 and paddles from defib #2, we delivered two nearly simultaneous electrical doses of 360J for a total electrical energy of 720J. Our patient's refractory VF immediately converted into a NSR. He immediately regained full consciousness, was following all commands, and was transferred to the cardiac critical care unit. He was discharged home seven days later without any evidence of neurological deficits.