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 .
Comparison of the effectiveness of intravenous diltiazem and metoprolol in the management of rapid ventricular rate in atrial fibrillation
Objective : To compare the effectiveness of intravenous ( IV ) diltiazem and metoprolol in the management of rapid ventricular rate in atrial fibrillation ( AF ) . Methods : This prospect i ve , r and omised study was conducted in the Emergency Department of the Uludag University Medical Faculty Hospital , Bursa , Turkey . Forty AF patients with a ventricular rate ⩾120/minute and systolic blood pressure ⩾95 mm Hg were included and r and omised to receive IV diltiazem 0.25 mg/kg ( maximum 25 mg ) or metoprolol 0.15 mg/kg ( maximum 10 mg ) over 2 minutes . Blood pressures and heart rate were measured at 2 , 5 , 10 , 15 , and 20 minutes . Successful treatment was defined as fall in ventricular rate to below 100/minute or decrease in ventricular rate by 20 % or return to sinus rhythm . Results : Between January 2000 and July 2002 , 40 patients ( 18 men , 22 women ) met the inclusion criteria . Of these 20 ( 8 men , 12 women ; mean age 60.2 years , range 31–82 ) received diltiazem and 20 ( 10 men , 10 women ; mean age 64.0 years , range 31–82 ) received metoprolol . The success rate at 20 minutes for diltiazem and metoprolol was 90 % ( n = 18 ) and 80 % ( n = 16 ) , respectively . The success rate at 2 minutes was higher in the diltiazem group . The percentage decrease in ventricular rate was higher in the diltiazem group at each time interval . None of the patients had hypotension . Conclusion : Both diltiazem and metoprolol  were safe and effective for the management of rapid ventricular rate in AF . However , the rate control effect began earlier and the percentage decrease in ventricular rate was higher with diltiazem than with metoprolol
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 .