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 .
DC cardioversion of persistent atrial fibrillation: a comparison of two protocols.
BACKGROUND Current guidelines for transthoracic direct-current cardioversion ( DCCV ) of atrial fibrillation ( AF ) recommend a step-up energy protocol . The aim of this study was to compare such a protocol with a protocol involving a high initial energy shock , anteroposterior paddle position and reversal of shock polarity , on cardioversion efficacy , total energy delivery , use of sedation and patient tolerability . METHODS 261 patients ( mean age 71+/-10 years , 62 % male ) referred for elective DCCV of persistent AF were enrolled . Patients were r and omised to either protocol A : ( 1 ) 200 J anteroapical , ( 2 ) 360 J anteroapical , ( 3 ) 360 J anteroposterior ; or protocol B : ( 1 ) 360 J anteroapical , ( 2 ) 360 J anteroposterior , and ( 3 ) 360 J posteroanterior . All procedures were performed under sedation with intravenous diazepam . RESULTS Protocol B improved shock success rates ( protocol A first shock success rate=42 % , protocol B=68 % , p<0.001 ; protocol A second shock success rate=72 % , protocol B 86 % , p=0.006 ; protocol A third shock success rate=83 % , protocol B=92 % , p=0.03 ) and required fewer shocks to achieve sinus rhythm ( 1.3+/-0.6 ) compared with protocol A ( 1.6+/-0.7 , p<0.001 ) . There were no differences in cumulative energy used ( protocol A 473+/-286 J , protocol B 436+/-273 J , p=0.24 ) or sedation requirements ( protocol A diazepam 22.1+/-9.0 mg , protocol B 21.7+/-8.9 mg , p=0.75 ) . Both protocol s were equally well tolerated by patients . CONCLUSION High initial energy increased success rates and decreased the number of shocks but result ed in similar cumulative energy delivery , sedation use and patient tolerability compared with a conventional step-up protocol
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 .