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 .
Randomised comparison of antero-lateral versus antero-posterior paddle positions for DC cardioversion of persistent atrial fibrillation.
We design ed a prospect i ve , r and omised , single-blind trial to compare the relative efficacy of antero-lateral versus antero-posterior paddle positions for DC cardioversion of persistent atrial fibrillation . A total of 59 patients were r and omised to cardioversion using st and ard gel pads placed either in the antero-lateral ( AL ) or antero-posterior ( AP ) positions . The first synchronised shock was given at 360 J ; if this was unsuccessful , a second shock of 360 J was given in the alternative position . We compared cardioversion success rate and energy requirements with each strategy . With the first 360 J DC shock , a significantly greater proportion of patients were restored to sinus rhythm from the antero-lateral position ( 18/30 ) compared to the antero-posterior position ( 10/29 ) ( P=0.048 ) . For those patients remaining in atrial fibrillation , there was no difference in the proportions cardioverted from the antero-lateral position ( 4/19 ) compared to the antero-posterior position ( 5/12 ) with the second 360 J DC shock ( P=0 . 22 ) . The total cardioversion success rate was 23/30 ( 77 % ) for antero-lateral followed by antero-posterior shocks compared to a success rate of 14/29 ( 48 % ) for antero-posterior followed by antero-lateral shocks , and this difference was significant ( P=0.024 ) . There was no significant difference in the mean energy delivered for patients r and omised to an initial antero-lateral shock ( 504 J ) , compared to patients given an initial antero-posterior shock ( 583 J ) ( P=0.1 ) . We conclude that the antero-lateral paddle position appears more effective for DC cardioversion of persistent atrial fibrillation
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 .