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 .
Verapamil versus digoxin and acute versus routine serial cardioversion for the improvement of rhythm control for persistent atrial fibrillation.
OBJECTIVES The VERDICT ( Verapamil Versus Digoxin and Acute Versus Routine Serial Cardioversion Trial ) is a prospect i ve , r and omized study to investigate whether : 1 ) acutely repeated serial electrical cardioversions ( ECVs ) after a relapse of atrial fibrillation ( AF ) ; and 2 ) prevention of intracellular calcium overload by verapamil , decrease intractability of AF . BACKGROUND Rhythm control is desirable in patients suffering from symptomatic AF . METHODS A total of 144 patients with persistent AF were included . Seventy-four ( 51 % ) patients were r and omized to the acute ( within 24 h ) and 70 ( 49 % ) patients to the routine serial ECVs , and 74 ( 51 % ) patients to verapamil and 70 ( 49 % ) patients to digoxin for rate control before ECV and continued during follow-up ( 2 x 2 factorial design ) . Class III antiarrhythmic drugs were used after a relapse of AF . Follow-up was 18 months . RESULTS At baseline , there were no significant differences between the groups , except for beta-blocker use in the verapamil versus digoxin group ( 38 % vs. 60 % , respectively , p = 0.01 ) . At follow-up , no difference in the occurrence of permanent AF between the acute and the routine cardioversion groups was observed ( 32 % [ 95 % confidence intervals ( CI ) ] 22 to 44 ) vs. 31 % [ 95 % CI 21 to 44 ] , respectively , p = NS ) , and also no difference between the verapamil- and the digoxin-r and omized patients ( 28 % [ 95 % CI 19 to 40 ] vs. 36 % [ 95 % CI 25 to 48 ] respectively , p = NS ) . Multivariate Cox regression analysis revealed that lone digoxin use was the only significant predictor of failure of rhythm control treatment ( hazard ratio 2.2 [ 95 % CI 1.1 to 4.4 ] , p = 0.02 ) . CONCLUSIONS An acute serial cardioversion strategy does not improve long-term rhythm control in comparison with a routine serial cardioversion strategy . Furthermore , verapamil has no beneficial effect in a serial cardioversion strategy
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 .