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 .
Maintenance of sinus rhythm with metoprolol CR initiated before cardioversion and repeated cardioversion of atrial fibrillation: a randomized double-blind placebo-controlled study.
AIMS To assess the effect of metoprolol in combination with repeated cardioversion on maintenance of sinus rhythm ( SR ) . METHODS AND RESULTS Consecutive out patients with persistent atrial fibrillation ( AF ) were r and omized to treatment with metoprolol CR or placebo in a double-blind fashion . Study treatment was started at least one week before direct current ( DC ) cardioversion . Patients were followed once a week during the first 6 weeks after cardioversion . In case of relapse during this period , a second cardioversion was performed . Total treatment time was 6 months . A total of 168 patients were r and omized to metoprolol  ( n = 83 ) or placebo ( n = 85 ) . The dose of study treatment at cardioversion was 169 + /- 47 mg in the metoprolol group and 180 + /- 40 mg in the placebo group ( P = 0.12 ) . In an intention-to-treat analysis , 46 patients ( 55 % ) in the metoprolol group and 34 patients ( 40 % ) in the placebo group ( P = 0.04 ) had SR 1 week after cardioversion , and 38 patients ( 46 % ) in the metoprolol group compared with 22 patients ( 26 % ) in the placebo group had SR after 6 months ( P < 0.01 ) . CONCLUSION A treatment strategy of metoprolol CR started before cardioversion in combination with prompt second cardioversion in case of early relapse ( 1 - 6 weeks ) significantly increases the proportion of patients in SR during six months of follow-up
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 .