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 .
Oral amiodarone increases the efficacy of direct-current cardioversion in restoration of sinus rhythm in patients with chronic atrial fibrillation.
AIMS Direct current cardioversion of persistent atrial fibrillation is one of the most widely used and effective treatments for the restoration of sinus rhythm , but may be hampered by a low success rate and a high percentage of early recurrence . Pre-treatment with amiodarone or a glucose-insulin-potassium solution could improve the efficacy of electrical cardioversion by reversing the partially depolarized diastolic potential of the subsidiary pacemakers in atrial fibrillation . In a controlled r and omized study , we assessed the effectiveness of electrical cardioversion in patients with persistent atrial fibrillation after pre-treatment with amiodarone or potassium infusion and the efficacy of amiodarone in maintaining sinus rhythm after electrical cardioversion . METHODS AND RESULTS Ninety-two patients with persistent atrial fibrillation ( > 2 weeks duration ) were prospect ively r and omized into three matched groups : A ( n=31 , oral amiodarone 400 mg . day(-1)1 month before and 200 mg . day(-1)2 months after cardioversion ) , B ( n=31 , 180 mg . day(-1)oral diltiazem 1 month before and 2 months after cardioversion and 80 mmol potassium , 50 UI insulin in 500 ml 30 % glucose solution 24 h before cardioversion ) and C ( n=30 , control patients , 180 mg . day(-1)oral diltiazem 1 month before and 2 months after cardioversion ) . Before cardioversion all patients were under 4 weeks effective oral anticoagulant therapy ( warfarin ) . Before electrical cardioversion , the rate of spontaneous conversion to sinus rhythm was higher in group A ( 25 % ) than groups B ( 6 % ) or C ( 3 % ) ( P<0.005 ) . Electrical cardioversion was more successful in group A ( 88 % ) than groups B ( 56 % ) or C ( 65 % ) ( P<0.05 ) , while the electrical thresholds for effective cardioversion were lower in group B than the other groups ( P<0.05 ) . Twenty-four hours after cardioversion , the early recurrence of atrial fibrillation was similar in the three groups ( P = ns ) , while at 2 months the recurrence rate was lower in group A ( 32 % ) than groups B ( 56 % ) or C ( 52 % ) ( P<0.01 ) . CONCLUSION Pre-treatment with low-dose oral amiodarone , compared with oral diltiazem or glucose-insulin-potassium treatments , induces a significantly high percentage of instances of spontaneous conversion , increases electrical cardioversion efficacy and reduces atrial fibrillation recurrence
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 .