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 .
A comparison of rectilinear and truncated exponential biphasic waveforms in elective cardioversion of atrial fibrillation: a prospective randomized controlled trial.
BACKGROUND Several different biphasic waveforms are used clinical ly , but few studies have compared their efficacy . The two main waveforms are the biphasic rectilinear ( BR ) and biphasic truncated exponential ( BTE ) waveforms , both of which have important differences , particularly at the extremes of transthoracic impedance . OBJECTIVE To compare the efficacy of two commonly used defibrillation waveforms in the elective cardioversion of atrial fibrillation . METHODS In a prospect i ve r and omized controlled study , sequential adult patients undergoing elective cardioversion for AF were recruited . Patients were r and omized to receive synchronized defibrillation using either a BR or BTE waveform , both using a 50J , 100J , 150J , 200J , 200J selected energy escalating protocol . Failure to cardiovert after the fifth shock was classed as failed defibrillation . The power of this study was 80 % with 5 % significance level to detect a difference of 20 % or greater between groups . Survival analysis was used to compare the total energy delivered to achieve successful cardioversion between groups . RESULTS A total of 202 patients were recruited , of which data are complete for 199 ( 100 BR ; 99 BTE ) .  Median number of shocks to achieve cardioversion was 2 for the BR waveform and 3 for the BTE waveform ( P = 0.059 ) . In the BR waveform group , 95/100 ( 95.0 % ) achieved sinus rhythm . In the BTE waveform group , 90/99 ( 90.9 % ) achieved sinus rhythm and this group required on average 117.1J more energy to achieve the outcome compared to the BR waveform group ( P = 0.838 ) . CONCLUSIONS BR and BTE waveforms show similar high efficacy in the elective cardioversion of atrial fibrillation
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 .