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 .
Anterior-posterior versus anterior-lateral electrode position for biphasic cardioversion of atrial fibrillation.
OBJECTIVE The aim of the study was to assess if the anterior-posterior electrode position for the conversion of atrial fibrillation using biphasic waveform shocks is more effective and needs less energy compared with the anterior-lateral position . BACKGROUND In several studies , anterior-posterior electrode position has been demonstrated to be superior to anterior-lateral position for the termination of atrial fibrillation using monophasic waveform shocks , but data regarding biphasic shocks are still emerging . PATIENTS AND METHODS Our prospect i ve , r and omized study enrolled 103 consecutive patients with atrial fibrillation who were referred for elective cardioversion .  The electrode position was r and omly selected to be anterior-lateral ( n=55 ) and anterior-posterior ( n=48 ) . A step-up protocol of 100 , 150 , 200 , and 300 J biphasic truncated exponential waveform shocks was used . RESULTS . Two groups with different paddle position were compared . There was no difference in age , gender , body mass index , ejection fraction , or left atrial size between the groups . Sinus rhythm restoration failed only in one patient in each group . Energy of 100 J was sufficiently effective in most patients in both groups . CONCLUSIONS The anterior-posterior electrode position during transthoracic cardioversion using biphasic waveform shocks has no advantages compared with more comfortable and common anterior-lateral position
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 .