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 .
Comparison of four single-drug regimens on ventricular rate and arrhythmia-related symptoms in patients with permanent atrial fibrillation.
Rate control of atrial fibrillation ( AF ) is a main treatment modality . However , data are scarce on the relative efficacy of calcium channel blockers and β blockers or between drugs within each class . The purpose of the present study was to compare the effect of 4 rate-reducing , once-daily drug regimens on the ventricular heart rate and arrhythmia-related symptoms in patients with permanent AF . We included 60 patients ( mean age 71 ± 9 years , 18 women ) with permanent AF in an investigator-blind cross-over study . Diltiazem 360 mg/day , verapamil 240 mg/day , metoprolol 100 mg/day , and carvedilol 25 mg/day were administered for 3 weeks in a r and omized sequence . The 24-hour heart rate was measured using Holter monitoring , and arrhythmia-related symptoms were assessed using the Symptom Checklist question naire before r and omization and on the last day of each treatment period . The 24-hour mean heart rate was 96 ± 12 beats/min at baseline ( no treatment ) , 75 ± 10 beats/min with diltiazem , 81 ± 11 beats/min with verapamil , 82 ± 11 beats/min with metoprolol , and 84 ± 11 beats/min with carvedilol . All drugs reduced the heart rate compared to baseline ( p < 0.001 for all ) . The 24-hour heart rate was significantly lower with diltiazem than with any other drug tested ( p < 0.001 for all ) . Compared to baseline , diltiazem significantly reduced both the frequency ( p < 0.001 ) and the severity ( p = 0.005 ) of symptoms . In contrast , verapamil reduced symptom frequency only ( p = 0.012 ) . In conclusion , diltiazem 360 mg/day was the most effective drug regimen for reducing the heart rate in patients with permanent AF . Arrhythmia-related symptoms were reduced by treatment with the calcium channel blockers diltiazem and verapamil , but not by the β blockers
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 .