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 .
Randomized comparison of anterolateral versus anteroposterior electrode position for biphasic external cardioversion of atrial fibrillation.
BACKGROUND In biphasic external cardioversion ( CV ) of atrial fibrillation ( AF ) , the influence of different electrode positions on efficacy and incidence of early recurrent atrial fibrillation is not known . This study compared anteroposterior ( AP ) vs anterolateral ( AL ) electrode positioning . METHODS Consecutive patients referred for CV of persistent AF were r and omized either to an AP or an AL electrode position . Biphasic external CV was performed with st and ardized electrode positions and rising energy delivery . RESULTS Both groups ( N = 123 , mean age 66 years , 71 % male , 83 % with structural cardiovascular disease or hypertension ) did not differ concerning age , sex , body mass index , chronic antiarrhythmic therapy , duration of AF  , left ventricular ejection fraction  , and left atrial diameter . Cumulative success rates were comparable ( AP 94.9 % vs AL 95.2 % , P = ns ) . First-shock efficacy did not differ ( AP 78.3 % vs AL 74.6 % , P = ns ) . Early recurrent atrial fibrillation ( AF relapse < 1 minute after successful CV ) occurred in 8.1 % ( AP 11.6 % vs AL 4.8 % , P = ns ) . Mean number of shocks was 1.3 per patient with the AP configuration and 1.4 per patient with the AL configuration ( P = ns ) . Mean cumulative energy delivery was also comparable ( AP 171 WS vs AL 198 WS , P = ns ) . CONCLUSIONS Both electrode positions are similar in biphasic external CV of AF with regard to acute success and early recurrent atrial fibrillation . Also , the number of shocks needed and energy delivery are comparable with both electrode configurations
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 .