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 .
Propafenone added to ibutilide increases conversion rates of persistent atrial fibrillation
Objective : To assess the effectiveness and safety of pharmacological conversion of persistent atrial fibrillation ( AF ) with a combined propafenone plus ibutilide regimen . Methods and results : 100 consecutive patients ( 66 men , mean ( SD ) age 65 ( 10 ) years ) with persistent AF ( mean ( SD ) duration 99 ( 92 ) days ) admitted for elective pharmacological cardioversion were r and omly assigned to treatment with either intravenous ibutilide ( 1 mg plus an additional 1 mg , if required ; n = 51 ) or oral propafenone ( 600 mg ) plus intravenous ibutilide at the same dose ( n = 49 ) . Success rates were 41.1 % ( 21 of 51 patients ) for ibutilide alone and 71.4 % ( 35 of 49 patients ) for propafenone plus ibutilide ( p = 0.0044 ) . However , cardioversion occurred earlier in the ibutilide alone group ( 55 ( 20 ) minutes ) compared with the combination group ( 81 ( 32 ) minutes , p = 0.0019 ) . A comparable increase in the QTc interval was observed in both groups but one case of sustained torsade de pointes , requiring electrical cardioversion , was observed in the propafenone plus ibutilide group . No other complications were noted during the hospitalisation period . Conclusion : Concurrent administration of propafenone plus ibutilide for pharmacological cardioversion of persistent AF is safe and more effective than ibutilide alone
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 .