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 .
Biphasic energy selection for transthoracic cardioversion of atrial fibrillation. The BEST AF Trial
Aims : To compare the efficacy and safety of an escalating energy protocol with a non-escalating energy protocol using an impedance compensated biphasic defibrillator for direct current cardioversion of atrial fibrillation ( AF ) . Methods and results : This prospect i ve multicentre r and omised trial enrolled 380 patients ( 248 male , mean ( SD ) age 67 ( 10 ) years ) with AF . Patients were r and omised to either an escalating energy protocol ( protocol A : 100 J , 150 J , 200 J , 200 J ) , or a non-escalating energy protocol ( protocol B : 200 J , 200 J , 200 J ) . Cardioversion was performed using an impedance compensated biphasic waveform .  First-shock success was significantly higher for those r and omised to 200 J than 100 J ( 71 % vs 48 % ; p<0.01 ) and for patients with a body mass index ( BMI ) > 25 kg/m2 ( 75 % vs 44 % ; p = 0.01 ) . In patients with a normal BMI there was no significant difference in first-shock success . There was also no significant difference between subsequent shocks or overall success . The use of a non-escalating protocol ( protocol B ) result ed in fewer shocks but with a higher cumulative energy . There was no difference in duration of procedure , amount of sedation administered or post-shock erythema between the groups . Conclusion : First-shock success was significantly higher , particularly in patients with a BMI > 25 kg/m2 , when a non-escalating initial 200 J energy was selected . The overall success , duration of procedure and amount of sedation administered , however , did not differ significantly between the two protocol
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 .