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 .
Monophasic versus biphasic waveform shocks for atrial fibrillation cardioversion in patients with concomitant amiodarone therapy.
AIMS With transthoracic cardioversion of atrial fibrillation ( AF ) , biphasic are more effective than monophasic waveforms . We sought to determine the ideal energy levels for biphasic waveforms . Methods We compared biphasic truncated exponential waveforms with monophasic damped sine waveform defibrillators , in a prospect i ve , single-centre , r and omized ( 1:1 ratio ) study . The study included 154 patients receiving concomitant amiodarone ;  77 received serial biphasic ( 50 , 100 , 150 , up to 175 J ) and 77 monophasic shocks ( 100 , 200 , 300 , up to 360 J ) , as necessary . Results First-shock efficacy was similar in the two groups ( 57 vs. 55 % , P = 0.871 , respectively ) , as were serial-shocks ( 90 vs. 92 % , P = 0.780 ) . Both groups received equal numbers of shocks ( 1.8 + /- 1.1 vs. 1.7 + /- 1.0 , P = 0.921 ) . In both groups , serum creatine kinase levels showed a small but significant increase . The increase was , however , higher in the monophasic group . CONCLUSION In patients with concomitant amiodarone therapy , biphasic truncated exponential shocks , using half the energy , were as effective as monophasic damped sine shocks . The biphasic scheme was not more efficacious for cardioverting AF . In our population , a first shock of at least 100 J seemed advisable with either waveform . If necessary , escalating shocks must be performed , but ideal levels of increase per shock are still uncertain for biphasic waveforms
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 .