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 .
Prospective, randomized comparison of two biphasic waveforms for the efficacy and safety of transthoracic biphasic cardioversion of atrial fibrillation.
OBJECTIVES The purpose of this study was to determine if there is a difference in commercially available biphasic waveforms . BACKGROUND Although the superiority of biphasic over monophasic waveforms for external cardioversion of atrial fibrillation ( AF ) is established , the relative efficacy of available biphasic waveforms is less clear . METHODS We compared the effectiveness of a biphasic truncated exponential ( BTE ) waveform and a biphasic rectilinear ( BR ) waveform for external cardioversion of AF . Patients ( N = 188 ) with AF were r and omized to receive transthoracic BR shocks ( 50 , 75 , 100 , 120 , 150 , 200 J ) or BTE shocks ( 50 , 70 , 100 , 125 , 150 , 200 , 300 , 360 J ) . Shock strength was escalated until success or maximum energy dose was achieved . If maximum shock strength failed , patients received the maximum shock of the opposite waveform . Analysis included 141 patients ( 71 BR , 70 BTE ; mean age 66.5 + /- 13.7 . Forty-seven r and omized patients were excluded because of flutter on precardioversion ECG upon blinded review ( n = 25 ) , presence of intracardiac thrombus ( n = 7 ) , or protocol deviation ( n = 15 ) . Groups were similar with regard to clinical and echocardiographic characteristics . RESULTS The success rate was similar for the two waveforms ( 93 % BR vs 97 BTE , P = .44 ) , although cumulative selected and delivered energy was less in the BTE group . Only AF duration was significantly different between successful and unsuccessful patients . No significant complications occurred . CONCLUSIONS Biphasic waveforms were very effective in transthoracic cardioversion of AF , and complication rates were low . No significant difference in efficacy was observed between BR and BTE waveforms . Impedance was not an important determinant of success for either biphasic waveform
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 .