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 .
VERDICT: the Verapamil versus Digoxin Cardioversion Trial: A randomized study on the role of calcium lowering for maintenance of sinus rhythm after cardioversion of persistent atrial fibrillation.
INTRODUCTION Many relapses of atrial fibrillation ( AF ) occur , especially during the first week(s ) after electrical cardioversion ( ECV ) . The aim of the present study was to compare in a r and omized design the efficacy of verapamil ( intracellular calcium lowering ) versus digoxin ( calcium increasing ) for maintenance of sinus rhythm after ECV . METHODS AND RESULTS Ninety-seven patients with persistent AF were r and omized to verapamil ( n = 49 ) or digoxin ( n = 48 ) for 1 month before and 1 month after ECV . The first month after ECV , patients recorded heart rhythm using daily transtelephonic monitoring . No additional antiarrhythmic drugs were given . Of the 97 patients , 43 patients ( 20 verapamil ) underwent ECV per protocol . Median previous AF duration was 18 and 26 days for verapamil and digoxin , respectively . There were no differences in atrial dimensions and underlying heart disease between the two groups . The success rate of ECV  was 75 % versus 83 % ( P = NS ) . After 1 month , 47 % versus 53 % ( P = NS ) had recurrence of AF . Median time to recurrence was 5 days ( range 0 to 26 ) versus 8 days ( range 2 to 28 ) ( P = NS ) , respectively . CONCLUSION St and -alone intracellular calcium lowering by verapamil around ECV does not enhance cardioversion outcome
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 .