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 .
Intravenous diltiazem is superior to intravenous amiodarone or digoxin for achieving ventricular rate control in patients with acute uncomplicated atrial fibrillation*
Objectives : To compare the clinical efficacy of intravenous diltiazem , digoxin , and amiodarone for acute ventricular rate ( VR ) control in patients with acute symptomatic atrial fibrillation ( AF ) necessitating hospitalization . Design : R and omized control trial . Setting : Acute emergency medical admission unit in a regional teaching hospital in Hong Kong . Patients : One hundred fifty adult patients with acute AF and rapid VR ( > 120 bpm ) . Interventions : Patients were r and omly assigned in 1:1:1 ratio to receive intravenous diltiazem , digoxin , or amiodarone for VR control . Measurements and Main Results : The primary end point was sustained VR control ( < 90 bpm ) within 24 hours ; the secondary end points included AF symptom improvement and length of hospitalization . At 24 hours , VR control was achieved in 119 of 150 patients ( 79 % ) . The time to VR control was significantly shorter among patients in the diltiazem group ( log-rank test , p < 0.0001 ) with the percentage of patients who achieved VR control being higher in the diltiazem group ( 90 % ) than the digoxin group ( 74 % ) and the amiodarone group ( 74 % ) . The median time to VR control was significantly shorter in the diltiazem group ( 3 hours , 1–21 hours ) compared with the digoxin ( 6 hours , 3–15 hours , p < 0.001 ) and amiodarone groups ( 7 hours , 1–18 hours , p = 0.003 ) . Furthermore , patients in the diltiazem group persistently had the lowest mean VR after the first hour of drug administration compared with the other two groups ( p < 0.05 ) . The diltiazem group had the largest reduction in AF symptom frequency score and severity score ( p < 0.0001 ) . In addition , length of hospital stay was significantly shorter in the diltiazem group ( 3.9 ± 1.6 days ) compared with digoxin ( 4.7 ± 2.1 days , p = 0.023 ) and amiodarone groups ( 4.7 ± 2.2 days , p = 0.038 ) . Conclusions : As compared with digoxin and amiodarone , intravenous diltiazem was safe and effective in achieving VR control to improve symptoms and to reduce hospital stay in patients with acute AF
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 .