They also have an increased risk for thromboembolism .
Comparing with age-matched controls , the relative risk for stroke is increased 2- to 7-fold in patients with nonrheumatic atrial fibrillation ( 3 , 8 , 13 ) , and the absolute risk for stroke is between 1 % and 5 % per year , depending on clinical characteristics ( 3 , 12 , 14 - 16 ) .
Paroxysmal atrial fibrillation disrupts the lives of patients ( 17 ) , but this perception may not be associated with frequency or duration of symptoms .
Warfarin therapy affects quality of life because of frequent blood testing and recommendations for limiting some activities .
Data Synthesis Does Aggressive Rhythm Control Improve Mortality and Morbidity Compared with Rate Control ?
Atrial fibrillation is the most common type of arrhythmia in adults , accounting for about one third of hospitalizations for arrhythmia ( 1 ) .
The prevalence increases from less than 1 % in persons younger than 60 years of age to more than 8 % in those older than 80 years of age ( 2 - 6 ) .
The incidence ranges from 0.2 % per year for men 30 to 39 years of age to 2.3 % per year in men 80 to 89 years of age ( 7 , 8) .
The age-adjusted incidence for women is about half that of men ( 9 ) .
The cardiac conditions most commonly associated with atrial fibrillation are rheumatic mitral valve disease , coronary artery disease , congestive heart failure , and hypertension ( 8 , 10 ) .
Noncardiac causes include hyperthyroidism , hypoxic conditions , surgery , and alcohol intoxication .
A predisposing condition exists in more than 90 % of cases ( 5 , 11 , 12 ) ; the remaining cases have what is called lone atrial fibrillation .
Patients with atrial fibrillation frequently have symptoms of hemodynamic compromise , ranging from irregular palpitations to the more insidious feeling of malaise .
Little is known about the direct effects of antiarrhythmic therapy and rate-control therapy on quality of life .
The American College of Cardiology/American Heart Association/European Society of Cardiology Task Force on Clinical Guidelines for the Management of Atrial Fibrillation classified atrial fibrillation into 4 types ( 20 ) : first detected episode , paroxysmal ( terminates spontaneously ) , persistent ( electrical or pharmacologic termination necessary ) , and permanent ( resistant to electrical or pharmacologic conversion or accepted by the physician ) .
The purpose of this review was to summarize the evidence that was available during formulation of the guidelines developed by the American College of Physicians ( ACP ) and the American Academy of Family Physicians ( AAFP ) for management of adult patients with nonpostoperative atrial fibrillation .
Although the relative benefits and risks of rate versus rhythm control are of paramount importance in the management of atrial fibrillation , studies directly addressed this issue only recently .
Transthoracic cardioversion of atrial fibrillation: comparison of rectilinear biphasic versus damped sine wave monophasic shocks.
BACKGROUND Clinical studies have shown that biphasic shocks are more effective than monophasic shocks for ventricular defibrillation . The purpose of this study was to compare the efficacy of a rectilinear biphasic waveform with a st and ard damped sine wave monophasic waveform for the transthoracic cardioversion of atrial fibrillation . METHODS AND RESULTS In this prospect i ve , r and omized , multicenter trial , patients undergoing transthoracic cardioversion of atrial fibrillation were r and omized to receive either damped sine wave monophasic or rectilinear biphasic shocks .  Patients r and omized to the monophasic protocol ( n=77 ) received sequential shocks of 100 , 200 , 300 , and 360 J. Patients r and omized to the biphasic protocol ( n=88 ) received sequential shocks of 70 , 120 , 150 , and 170 J. First-shock efficacy with the 70-J biphasic waveform ( 60 of 88 patients , 68 % ) was significantly greater than that with the 100-J monophasic waveform ( 16 of 77 patients , 21 % , P<0.0001 ) , and it was achieved with 50 % less delivered current ( 11+/-1 versus 22+/-4 A , P<0.0001 ) . Similarly , the cumulative efficacy with the biphasic waveform ( 83 of 88 patients , 94 % ) was significantly greater than that with the monophasic waveform ( 61 of 77 patients , 79 % ; P=0.005 ) . The following 3 variables were independently associated with successful cardioversion : use of a biphasic waveform ( relative risk , 4.2 ; 95 % confidence intervals , 1.3 to 13.9 ; P=0.02 ) , transthoracic impedance ( relative risk , 0.64 per 10-Omega increase in impedance ; 95 % confidence intervals , 0.46 to 0.90 ; P=0.005 ) , and duration of atrial fibrillation ( relative risk , 0.97 per 30 days of atrial fibrillation ; 95 % confidence intervals , 0.96 to 0.99 ; P=0.02 ) . CONCLUSIONS For transthoracic cardioversion of atrial fibrillation , rectilinear biphasic shocks have greater efficacy ( and require less energy ) than damped sine wave monophasic shocks
They also have an increased risk for thromboembolism .
Comparing with age-matched controls , the relative risk for stroke is increased 2- to 7-fold in patients with nonrheumatic atrial fibrillation ( 3 , 8 , 13 ) , and the absolute risk for stroke is between 1 % and 5 % per year , depending on clinical characteristics ( 3 , 12 , 14 - 16 ) .
Paroxysmal atrial fibrillation disrupts the lives of patients ( 17 ) , but this perception may not be associated with frequency or duration of symptoms .
Warfarin therapy affects quality of life because of frequent blood testing and recommendations for limiting some activities .
Data Synthesis Does Aggressive Rhythm Control Improve Mortality and Morbidity Compared with Rate Control ?
Atrial fibrillation is the most common type of arrhythmia in adults , accounting for about one third of hospitalizations for arrhythmia ( 1 ) .
The prevalence increases from less than 1 % in persons younger than 60 years of age to more than 8 % in those older than 80 years of age ( 2 - 6 ) .
The incidence ranges from 0.2 % per year for men 30 to 39 years of age to 2.3 % per year in men 80 to 89 years of age ( 7 , 8) .
The age-adjusted incidence for women is about half that of men ( 9 ) .
The cardiac conditions most commonly associated with atrial fibrillation are rheumatic mitral valve disease , coronary artery disease , congestive heart failure , and hypertension ( 8 , 10 ) .
Noncardiac causes include hyperthyroidism , hypoxic conditions , surgery , and alcohol intoxication .
A predisposing condition exists in more than 90 % of cases ( 5 , 11 , 12 ) ; the remaining cases have what is called lone atrial fibrillation .
Patients with atrial fibrillation frequently have symptoms of hemodynamic compromise , ranging from irregular palpitations to the more insidious feeling of malaise .
Little is known about the direct effects of antiarrhythmic therapy and rate-control therapy on quality of life .
The American College of Cardiology/American Heart Association/European Society of Cardiology Task Force on Clinical Guidelines for the Management of Atrial Fibrillation classified atrial fibrillation into 4 types ( 20 ) : first detected episode , paroxysmal ( terminates spontaneously ) , persistent ( electrical or pharmacologic termination necessary ) , and permanent ( resistant to electrical or pharmacologic conversion or accepted by the physician ) .
The purpose of this review was to summarize the evidence that was available during formulation of the guidelines developed by the American College of Physicians ( ACP ) and the American Academy of Family Physicians ( AAFP ) for management of adult patients with nonpostoperative atrial fibrillation .
Although the relative benefits and risks of rate versus rhythm control are of paramount importance in the management of atrial fibrillation , studies directly addressed this issue only recently .