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 .
A trial of self-adhesive patch electrodes and hand-held paddle electrodes for external cardioversion of atrial fibrillation (MOBIPAPA).
AIMS External electrical cardioversion is the method of choice to terminate persistent atrial fibrillation . Whether the type of shock electrode affects cardioversion success is not known . We tested whether h and -held steel electrodes improve cardioversion outcome with monophasic or biphasic shocks when compared with adhesive patch electrodes . METHODS AND RESULTS Two hundred and one consecutive patients with persistent atrial fibrillation ( 147 male , mean age 63+/-1 years , duration of atrial fibrillation 6.3+/-1 months ) were r and omly assigned to cardioversion using either a sinusoidal monophasic or a truncated exponential biphasic shock wave form . The first half of patients were cardioverted using adhesive patch electrodes , the second half using h and -held steel paddle electrodes , and all patients using an anterior-posterior electrode position . Paddle electrodes successfully cardioverted 100/104 patients ( 96 % ) and patch electrodes 85/97 patients ( 88 % , P=0.04 ) . This effect was comparable to that of biphasic shocks : biphasic shocks  cardioverted 102/104 patients ( 98 % ) and monophasic shocks 83/97 patients ( 86 % , P=0.001 ) . A beneficial effect of paddle electrodes was observed for both shock wave forms . After cross-over from an ineffective monophasic to a biphasic shock , cardioversion was successful in 198/201 ( 98.5 % ) patients . Unsuccessful cardioversion after cross-over ( 3/201 patients ) only occurred with patch electrodes ( P=0.07 ) . CONCLUSION H and -held paddle electrodes increase success of external cardioversion of atrial fibrillation in this trial . This increase is of similar magnitude as the increase in cardioversion success achieved with biphasic shocks . A combination of biphasic shocks , paddle electrodes , and an anterior-posterior electrode position renders outcome of external cardioversion almost always successful ( 104/104 patients in this trial )
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 .