Low energy level internal direct current shocks were used to defibrillate the hearts of 168 patients during procedures performed on cardiopulmonary bypass. In all cases, the core temperature was greater than 32 degrees C and care was taken to correct hypokalaemia and acid-base balance prior to defibrillation. In 78 patients (46%), defibrillation required 2 joules or less, and in 139 (82.7%) cases, defibrillation was effected with 4 joules or less. Only 4 patients required more than 10 joules to defibrillate the heart. This study shows that it is possible to defibrillate hearts during cardiopulmonary bypass with energy levels well below the 20-30 joule shocks commonly used.