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 .
Effect of shock polarity on the efficacy of transthoracic atrial defibrillation.
BACKGROUND The energy requirement for internal ventricular defibrillation is reduced by reversal of shock polarity . The influence of shock polarity on the efficacy of transthoracic atrial defibrillation is unknown . METHODS This prospect i ve , r and omized study enrolled 110 consecutive patients who were referred for elective cardioversion of persistent atrial fibrillation ( AF ) .  The electrodes were placed in the anteroposterior position . The patients were r and omized to receive either st and ard ( anterior pad = cathode ) or reversed polarity ( anterior pad = anode ) shocks with a damped sinusoidal monophasic waveform . A step-up protocol was used to estimate the cardioversion threshold . The initial shock energy was 50 J , with subsequent increments to 100 , 200 , 300 , and 360 J in the event of cardioversion failure . RESULTS Sixty-four percent of the patient population were men , with a mean age of 66 + /- 13 years and a mean duration of AF of 242 + /- 556 days . The overall success rates of cardioversion were 84 % for st and ard polarity and 78 % for reversed polarity ( P not significant ) . Among the patients who were successfully cardioverted , the mean atrial defibrillation threshold was 198 + /- 103 J for st and ard polarity and 212 + /- 107 J for reversed polarity ( P not significant ) . CONCLUSIONS Reversal of shock polarity does not improve transthoracic cardioversion efficacy with a st and ard damped sinusoidal monophasic waveform . Alternate strategies should be considered for patients who fail external cardioversion , such as adjunctive pharmacologic treatment , use of a biphasic shock waveform , or internal cardioversion
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 .