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 .
Anterior-posterior versus anterior-lateral electrode positions for external cardioversion of atrial fibrillation: a randomised trial
BACKGROUND External cardioversion is a readily available treatment for persistent atrial fibrillation . Although anatomical and electrophysiological considerations suggest that an anterior-posterior electrode position should create a more homogeneous shock-field gradient throughout the atria than an anterior-lateral position , both electrode positions are equally recommended for external cardioversion in current guidelines . We undertook a r and omised trial comparing the two positions with the endpoint of successful cardioversion . METHODS 108 consecutive patients ( mean age 60 years [ SD 16 ] ) with persistent atrial fibrillation ( median duration 5 months , range 0.1 - 120 ) underwent elective external cardioversion by a st and ardised step-up protocol with increasing shock strengths ( 50 - 360 J ) . Electrode positions were r and omly assigned as anterior-lateral or anterior-posterior . If sinus rhythm was not achieved with 360 J energy , a single cross-over shock ( 360 J ) was applied with the other electrode configuration . A planned interim analysis was done after these patients had been recruited ; it was by intention to treat . FINDINGS Cardioversion was successful in a higher proportion of the anterior-posterior than the anterior-lateral group ( 50 of 52 [ 96 % ] vs 44 of 56 [ 78 % ] , difference 23.7 % ( 95 % CI 9.1 - 37.8 , p=0.009 ) . Cross-over from the anterior-lateral to the anterior-posterior electrode position was successful in eight of 12 patients , whereas cross-over in the other direction was not successful ( two patients ) . After cross-over , cardioversion was successful in 102 of 108 r and omised patients ( 94 % ) . INTERPRETATION An anterior-posterior electrode position is more effective than the anterior-lateral position for external cardioversion of persistent atrial fibrillation . These results should be considered in clinical practice , for the design of defibrillation electrode pads , and when guidelines for cardioversion of atrial fibrillation are up date
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 .