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 .
Signal-averaged P wave reflects change in atrial electrophysiological substrate afforded by verapamil following cardioversion from atrial fibrillation.
BACKGROUND Detailed analysis of signal-averaged P waves ( SAPW ) can provide insights into atrial electrophysiology . Abbreviated dosing of verapamil prior to cardioversion improves outcome at 1 week postcardioversion . The mechanism by which verapamil manifests benefit is uncertain . We hypothesized the SAPW would reflect any change in atrial electrophysiologic substrate afforded by verapamil when compared with controls . METHODS We investigated 23 patients attending external cardioversion of persistent atrial fibrillation ( AF ) ( 6 female ; mean age 68 years ) . Patients were r and omized to verapamil 240 mg daily in three divided doses 3 days before cardioversion and 1 week after , or usual medication .  SAPW recordings were performed during sinus rhythm ( SR ) immediately after cardioversion , at 24 hours and 1 week . RESULTS The groups were comparable in terms of age , gender , left atrial size , and duration of AF . Eight of nine patients prescribed verapamil maintained SR at 1 week postcardioversion compared with 6 of 14 controls ( P = 0.027 ) . SAPW spectral analysis delivered higher energy for patients prescribed verapamil ( median ( IQ range ) ) ; 40.8 ( 33.4 - 95.1 ) versus 25.7 ( 19.0 - 38.0 ) for energy within 20 - 150 Hz , P20 ( microV(2)x s ; P = 0.03 ) . There was no difference in P-wave duration ( PWD ) or root mean square of the terminal 30 ms between the two groups . Early reinitiation occurred in patients with significantly lower P-wave energy 19.6 ( 12.9 - 24.6 ) versus 39.9 ( 24.0 - 47.0 ) ( P = 0.017 ) . CONCLUSIONS Verapamil 240 mg daily for 3 days prior to cardioversion and 1 week after reduces early recurrence of AF . The SAPW observations indicate change in atrial electrophysiologic substrate might be responsible for benefit afforded by verapamil
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 .