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 .
Biphasic versus monophasic cardioversion in shock-resistant atrial fibrillation:.
UNLABELLED Biphasic versus Monophasic Cardioversion . INTRODUCTION Cardioversion of atrial fibrillation using monophasic transthoracic shocks occasionally is ineffective . Biphasic cardioversion requires less energy than monophasic cardioversion , but its efficacy in shock-resistant atrial fibrillation is unknown . Thus , we compared the efficacy of cardioversion using biphasic versus monophasic waveform shocks in patients with atrial fibrillation previously refractory to monophasic cardioversion . METHODS AND RESULTS Fifty-six patients with prior failed monophasic cardioversion were r and omized to either a 360-J monophasic damped sinusoidal shock or biphasic truncated exponential shocks at 150 J , followed by 200 J and then 360 J , if necessary . If either waveform failed , patients were crossed over to the other waveform . The primary endpoint was defined as the proportion of patients achieving sinus rhythm following initial r and omized therapy . Stepwise multivariate logistic regression examined independent predictors of shock success , including patient age , sex , left atrial diameter , body mass index , drug therapy , and waveform . Twenty-eight patients were r and omized to the biphasic shocks and 28 to the monophasic shocks .  Sinus rhythm was restored in 61 % of patients with biphasic versus 18 % with monophasic shocks ( P = 0.001 ) . Seventy-eight percent success was achieved in patients who crossed over to the biphasic shock after failing monophasic cardioversion , whereas only 33 % were successfully cardioverted with a monophasic shock after crossover from biphasic shock ( P = 0.02 ) . Overall , 69 % of patients who received a biphasic shock at any point in the protocol were cardioverted successfully , compared to 21 % with the monophasic shock ( P < 0.0001 ) . The type of shock was the strongest predictor of shock success ( P = 0.0001 ) in multivariate logistic regression . CONCLUSION An ascending sequence of 150- , 200- , and 360-J transthoracic biphasic cardioversion shocks are successful more often than a single 360-J monophasic shock . Thus , biphasic shocks should be the recommended configuration of choice for all cardioversions
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 .