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 .
Control of Heart Rate Versus Rhythm in Rheumatic Atrial Fibrillation: A Randomized Study
Background : Patients with rheumatic heart disease with atrial fibrillation incur significant morbidity and mortality . Which approach , ventricular rate control or maintenance of sinus rhythm , in this setting might be superior is not known . The role of amiodarone in this patient population for maintaining sinus rhythm has not been evaluated . Methods and Results : We prospect ively studied 144 patients with chronic rheumatic atrial fibrillation in a double-blind protocol in which rhythm control ( group I ) , comprising 48 patients each with amiodarone ( group Ia ) and placebo ( group Ib ) , were compared with each other and with patients in a ventricular rate control group ( group II ) in which the effects by diltiazem were determined ( n = 48 , open-label ) . Direct current cardioversion was attempted in group I. The mean age of the study population was 38.6 ± 10.3 years , left atrial size , 4.7 ±0.6 cm ; atrial fibrillation duration , 6.1 ± 5.4 years ; and 72.9 % had valvular interventions performed . At 1 year , 45 patients with sinus rhythm in group I compared with 48 in group II demonstrated an increase in exercise time ( 2.6 ± 1.9 vs. 0.6 ± 2.5 min , P = .001 ) , improvement in New York Heart Association class of 1 or more ( P = .002 ) , and improvement in the quality -of-life score of one or greater ( P = 0.01 ) with no difference in hospitalizations , systemic bleeds , or thromboembolism . Five patients died in group II ; none died in group I ( P = .02 ) . In group I , 73 of 87 ( 83.9 % ) patients converted to sinus rhythm and 45 of 86 ( 52.3 % ) patients maintained the rhythm at 1 year . Conversion rates were 38 of 43 ( 88.4 % ) with amiodarone versus 34 of 44 ( 77.3 % ) with placebo ( P = .49 ) ; the corresponding rate for maintaining sinus rhythm was 29 of 42 ( 69.1 % ) versus 16 of 44 ( 36.4 % ) ( P = .008 ) . A larger number of electrical cardioversions were required in the placebo group ( 2.1 vs. 1.4 , P = .011 ) . Conclusions : Maintenance of sinus rhythm is superior to ventricular rate control in patients with rheumatic atrial fibrillation with respect to effects on exercise capacity , quality of life , morbidity , and possibly mortality . Sinus rhythm could be restored in most patients , and amiodarone was superior to placebo in the restoration and maintenance of sinus rhythm
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 .