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 .
Impact of biphasic electrical cardioversion of atrial fibrillation on early recurrent atrial fibrillation and shock efficacy.
INTRODUCTION  Early recurrent atrial fibrillation ( ERAF ) after external cardioversion of atrial fibrillation ( AF ) occurs in 12 % to 26 % of patients . Whether biphasic cardioversion has an impact on the incidence of ERAF after cardioversion of AF is unclear . METHODS AND RESULTS Consecutive patients ( n = 216 , mean age 66 years , 71 % male , 88 % with structural cardiovascular disease or hypertension ) underwent cardioversion with a biphasic ( Bi ) or monophasic ( Mo ) shock waveform in r and omized fashion . Energies used were 120 - 150 - 200 - 200 Ws ( Bi ) or 200 - 300 - 360 - 360 Ws ( Mo ) . The two study groups ( Bi vs Mo ) did not differ with regard to age , sex , body mass index , underlying cardiovascular disease , left atrial diameter , left ventricular ejection fraction , duration of AF fibrillation , and antiarrhythmic drug therapy . Mean delivered energy was significantly lower in the Bi group ( Bi : 186 + /- 143 Ws vs Mo : 324 + /- 227 Ws ; P < 0.001 ) . Overall incidence of ERAF ( AF relapse within 1 minute after successful cardioversion ) was 8.9 % and showed no difference between the two groups ( Bi : 8.1 % vs Mo : 9.7 % , P = NS ) . Cardioversion was successful in 95.4 % of patients . The success rate was comparable in both groups ( Bi : 94.3 % vs Mo 96.8 % ; P = NS ) . First shock efficacy did not differ between Bi and Mo ( 76.4 % vs 67.7 % ; P = NS ) . Mean number of shocks were 1.4 shocks per patient in both groups . CONCLUSION Biphasic cardioversion allows comparable success rates with significantly lower energies . However , the incidence of ERAF is not influenced by biphasic cardioversion . With the energies used , biphasic and monophasic shock waveforms are comparable with regard to first shock and cumulative shock efficacy
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 .