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 .
Sinus rhythm maintenance following DC cardioversion of atrial fibrillation is not improved by temporary precardioversion treatment with oral verapamil
Objective : To evaluate prospect ively the effects of pretreatment with verapamil on the maintenance of sinus rhythm after direct current ( DC ) cardioversion . Design : R and omised , active control , open label , parallel group comparison of verapamil versus digoxin . Setting s : Multicentre study in three teaching and three non-teaching hospitals in Sweden . Patients : 100 consecutive patients with atrial fibrillation ( AF ) of at least four weeks ’ duration and indications for cardioversion were assigned r and omly to two groups , one treated with verapamil ( verapamil group ) and the other with digoxin ( digoxin group ) before cardioversion . Fifty patients were assigned r and omly to each treatment arm . After dropout of four patients from the digoxin group and seven patients from the verapamil group , data obtained from 89 patients were analysed . Interventions : After r and omly assigned pretreatment with either verapamil or digoxin for four weeks , DC cardioversion was performed . If sinus rhythm was restored then verapamil treatment was discontinued . Main outcome measures : The rate of AF recurrence was assessed one , four , eight , and 12 weeks after cardioversion . Results : 6 patients in the verapamil treated group and none in the digoxin treated group reverted to sinus rhythm spontaneously ( p < 0.05 ) . DC cardioversion restored sinus rhythm in 24 of 37 ( 65 % ) patients in the verapamil group and 41 of 46 patients ( 89 % ) in the digoxin group ( p < 0.05 ) . After 12 weeks ’ follow up 28 % ( 13 of 46 ) of digoxin pretreated patients versus 9 % ( four of 43 ) of verapamil pretreated patients remained in sinus rhythm ( p < 0.05 ) . Conclusion : Pretreatment with verapamil alone does not improve maintenance of sinus rhythm after DC cardioversion in patients with AF . The rate of spontaneous cardioversion may be improved by verapamil
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 .