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A new technique of internal transcatheter cardioversion of chronic atrial fibrillation using high energy shocks (200 to 300 joules) was performed in 10 patients. In all patients, external cardioversion (300 to 400 joules) and pharmacologic therapy failed to restore sinus rhythm. Atrial fibrillation was poorly tolerated despite digitalis therapy alone (five patients) or in combination with amiodarone (five patients). High energy transcatheter cardioversion was performed by pulling back the atrioventricular (AV) junction catheter just inferior to the site of His bundle recording and delivering the shock between a proximal electrode (catheter) and backplate (anode).