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 .
Carvedilol alone or in combination with digoxin for the management of atrial fibrillation in patients with heart failure?
OBJECTIVES This study examined the relative merits of digoxin , carvedilol , and their combination for the management of patients with atrial fibrillation ( AF ) and heart failure ( HF ) . BACKGROUND In patients with AF and HF , both digoxin and beta-blockers reduce the ventricular rate , and both may improve symptoms , but only beta-blockers have been shown to improve prognosis . If combined therapy is not superior to beta-blockers alone , treatment of patients with HF and AF could be simplified by stopping digoxin . METHODS We enrolled 47 patients ( 29 males ; mean age 68 years ) with persistent AF and HF ( mean left ventricular ejection fraction [ LVEF ] 24 % ) in a r and omized , double-blinded , placebo-controlled study . In the first phase of the study , digoxin was compared with the combination of digoxin and carvedilol ( four months ) . In the second phase , digoxin was withdrawn in a double-blinded manner in the carvedilol-treated arm , thus allowing a comparison between digoxin and carvedilol ( six months ) . Investigations were undertaken at baseline and at the end of each phase . RESULTS Compared with digoxin alone , combination therapy lowered the ventricular rate on 24-h ambulatory electrocardiographic monitoring ( p < 0.0001 ) and during submaximal exercise ( p < 0.05 ) , whereas LVEF ( p < 0.05 ) and symptom score ( p < 0.05 ) improved . In phase 2 , there was no significant difference between digoxin alone and carvedilol alone in any variable . The mean ventricular rate rose and LVEF fell when patients switched from combination therapy to carvedilol alone . Six-minute walk distance was not significantly influenced by any therapy . CONCLUSIONS The combination of carvedilol and digoxin appears generally superior to either carvedilol or digoxin alone in the management of AF in patients with HF
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 .