D. Restoration of sinus rhythm for monophasic vs. biphasic waveforms .
Another study showed that PVI result ed in long-term restoration
Atrial fibrillation ( AF ) is a major public health problem in the United States .
More than 2.3 million Americans are estimated to have AF ( 1 ) .
The known association between AF and substantial mortality , morbidity , and health care costs compounds the effect of this condition .
Not only is the risk for death in patients with AF twice that of patients without it , but AF can result in myocardial ischemia and infa rct ion , exacerbate heart failure ( HF ) , and cause tachycardia-induced cardiomyopathy if the ventricular rate is not well-controlled ( 25 ) .
The most dreaded complication of AF is thromboembolism , especially stroke ( 6 ) .
In some patients , AF or therapies to manage this condition can severely depreciate quality of life ( 710 ) .
Furthermore , the management of AF and its complications is responsible for nearly $ 16 billion in additional costs to the U.S. health care system per year ( 11 ) .
We conducted this systematic review to evaluate the comparative safety and effectiveness of rate- versus rhythm-control strategies ;  medications used for ventricular rate control ; strict versus more lenient rate-control strategies ; nonpharmacologic rate-control therapies  versus medications ; electrical cardioversion and antiarrhythmic medications  for restoration of sinus rhythm ;  and  catheter ablation , surgical ablation , and antiarrhythmic medications  for maintenance of sinus rhythm .
Sotalol vs metoprolol for ventricular rate control in patients with chronic atrial fibrillation who have undergone digitalization: a single-blinded crossover study.
AIMS To compare the effects of sotalol and metoprolol on heart rate , during isotonic ( ITE ) and isometric ( IME ) exercise and daily activities , in digitalized patients with chronic atrial fibrillation . METHODS AND RESULTS The study had a r and omized , single-blinded , crossover design . Twenty-three patients with chronic atrial fibrillation received placebo for 4 weeks , followed by a 4-week period of treatment with sotalol and metoprolol in r and om order . At the end of each period , the patients were assessed with  24-h ECG monitoring , a  cardiopulmonary exercise test  and a  h and grip manoeuvre .  Both agents produced a lower heart rate than placebo at rest and at all levels of isotonic exercise ( P < 0.001 ) without affecting oxygen uptake . Sotalol produced a lower heart rate than metoprolol only at submaximal exercise ( 116 + /- 9 bpm for sotalol vs 125 + /- 11 bpm for metoprolol , P < 0.001 ) . During isometric exercise , sotalol produced a lower maximum heart rate than did metoprolol ( 113 + /- 22 vs 129 + /- 18 bpm , respectively ) . Both agents produced a lower mean heart rate than placebo over 24 h ( P < 0.001 for all ) , while sotalol produced a lower mean heart rate than metoprolol during the daytime ( P < 0.01 ) . CONCLUSION Sotalol is a safe and effective agent for control of heart rate in digitalized patients with atrial fibrillation . Sotalol is superior to metoprolol at submaximal exercise , result ing in better rate control during daily activities
D. Restoration of sinus rhythm for monophasic vs. biphasic waveforms .
Another study showed that PVI result ed in long-term restoration
Atrial fibrillation ( AF ) is a major public health problem in the United States .
More than 2.3 million Americans are estimated to have AF ( 1 ) .
The known association between AF and substantial mortality , morbidity , and health care costs compounds the effect of this condition .
Not only is the risk for death in patients with AF twice that of patients without it , but AF can result in myocardial ischemia and infa rct ion , exacerbate heart failure ( HF ) , and cause tachycardia-induced cardiomyopathy if the ventricular rate is not well-controlled ( 25 ) .
The most dreaded complication of AF is thromboembolism , especially stroke ( 6 ) .
In some patients , AF or therapies to manage this condition can severely depreciate quality of life ( 710 ) .
Furthermore , the management of AF and its complications is responsible for nearly $ 16 billion in additional costs to the U.S. health care system per year ( 11 ) .
We conducted this systematic review to evaluate the comparative safety and effectiveness of rate- versus rhythm-control strategies ;  medications used for ventricular rate control ; strict versus more lenient rate-control strategies ; nonpharmacologic rate-control therapies  versus medications ; electrical cardioversion and antiarrhythmic medications  for restoration of sinus rhythm ;  and  catheter ablation , surgical ablation , and antiarrhythmic medications  for maintenance of sinus rhythm .