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The last 5 years have seen an explosion in the number of studies assessing the efficacy of antiarrhythmic agents for the acute conversion of atrial fibrillation to sinus rhythm.A variety of agents have been studied, including digoxin, ibutilide, propafenone, flecainide, procainamide, amiodarone, and sotalol.As a result of these trials, we have learned a great deal about the epidemiology of atrial fibrillation of recent onset.The importance of having a placebo population in these trials has been brought to light by the high incidence of spontaneous reversion to sinus rhythm, ranging from 20% to 70%, particularly when atrial fibrillation is less than 24 hours in duration. This striking variation in the incidence of reversion to sinus rhythm depends greatly on the duration of atrial fibrillation, which along with the presence of structural heart disease has become the most important factor determining the likelihood that a patient with atrial fibrillation will spontaneously revert to sinus rhythm.

Monoclonal antibodies are homogeneous immunoglobulin proteins produced to a preselected antigen. These antibodies react to specific sites on the antigen and, if the antigen is part of the cell surface, mediate a destructive response against that cell. The antibodies may be useful in patients with malignancy to detect tumor-related antigens in patient serum, to localize the presence of metastatic disease, and to serve as therapeutic agents. The technology of monoclonal antibodies is rapidly evolving and will soon be part of routine treatment of patients with malignancy.