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 .
Amiodarone versus diltiazem for rate control in critically ill patients with atrial tachyarrhythmias
Objective To compare the rate-lowering effect of diltiazem and two amiodarone regimens in critically ill patients with recent-onset atrial tachyarrhythmias . Design Prospect i ve , r and omized , controlled study . Setting Medical cardiologic intensive care unit in a university hospital . Patients Sixty critically ill patients ( Acute Physiology and Chronic Health Evaluation [ APACHE ] III score 70 ± 30 , age 67 ± 10 yrs ) . Interventions Patients with atrial fibrillation ( n = 57 ) , atrial flutter ( n = 2 ) , or atrial tachycardia ( n = 1 , and a heart rate consistently > 120 beats/min over 30 mins were r and omly assigned to one of three intravenous treatment regimens . Group 1 received diltiazem in a 25-mg bolus followed by a continuous infusion of 20 mg/hr for 24 hrs , group 2 received amiodarone in a 300-mg bolus , and group 3 received amiodarone in a 300-mg bolus followed by 45 mg/hr for 24 hrs . Measurements and Main Results The primary study end point was a > 30 % rate reduction within 4 hrs . The secondary study end point was a heart rate < 120 beats/min ( a patient was considered to have uncontrolled tachycardia if heart rate was > 120 beats/min 4 hrs after study drug ) . The primary study end point was achieved in 14/20 ( 70 % ) , 11/20 ( 55 % ) , and 15/20 ( 75 % ) of patients in groups 1 , 2 , and 3 , respectively ( & khgr;2 = 1.95 , p = .38 ) . Uncontrolled tachycardia was more frequently observed in group 2 ( 0/20 , 9/29 [ 55 % ] , and 1/20 [ 5 % ] of patients in groups 1 , 2 , and 3 , respectively ; & khgr;2 = 17 , p = .00016 ) . In patients achieving tachycardia control , diltiazem showed a significantly better rate reduction ( p = .0001 group 1 vs. group 3 , p = .0001 over time;p = .0001 group 1 vs. group 2 , p = .001 over time ) when compared with the amiodarone  groups . Premature drug discontinuation due to hypotension was required significantly more often in group 1 ( 6/20 [ 30 % ] , 0/20 , and 1/20 [ 5 % ] for groups 1 , 2 , and 3 , respectively ; & khgr;2 = 10 , p = .01 ) . Conclusion Sufficient rate control can be achieved in critically ill patients with atrial tachyarrhythmias using either diltiazem or amiodarone . Although diltiazem allowed for significantly better 24-hr heart rate control , this effect was offset by a significantly higher incidence of hypotension requiring discontinuation of the drug . Amiodarone may be an alternative in patients with severe hemodynamic compromise
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 .