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 .
A randomized, prospective comparison of anterior and posterior approaches to atrioventricular junction modification of medically refractory atrial fibrillation.
To compare the safety and efficacy of anterior versus posterior approach for atrioventricular ( AV ) junction modification , 40 patients with medically refractory paroxysmal ( PAF ) or chronic atrial fibrillation ( AF ) were r and omly assigned to receive AV junction modification with an anterior or posterior approach . If the ablation session had taken more than 1 hour without success , the alternative ablation approach was attempted . Among the 18 patients assigned to receive the anterior approach , 14 ( 78 % ) had a primary success . One ( 5 % ) patient had complete AV block after ablation . Three patients crossed over to the posterior approach and had a successful outcome . Fourteen ( 64 % ) of 22 patients initially treated with the posterior approach had primary success . One ( 4 % ) patient developed complete AV block . Seven patients crossed over to the anterior approach and had a successful outcome . The primary success rate ( 14/18 vs 14/22 , P = NS ) , incidence of transient AV block ( 3/18 vs 3/22 , P = NS ) , and complete AV block ( 1/18 vs 1/22 , P = NS ) were similar between the anterior approach and posterior approach . The major differences between the two groups showed more radiofrequency pulses ( 10 + /- 4 vs 6 + /- 3 pulses , P < 0.01 ) , longer procedure duration ( 50 + /- 24 vs 28 + /- 18 minutes , P < 0.01 ) , and longer fluoroscopy exposure time ( 28 + /- 17 vs 16 + /- 8 minutes , P < 0.01 ) in the patients who had primary success with the posterior approach . In conclusion , this study demonstrated that ( 1 ) the two techniques had similar efficacies ; ( 2 ) if one approach was ineffective , switching to the other approach might be safe ; ( 3 ) combining these two approaches result ed in overall improvement in the success rate of this procedure , and ( 4 ) the posterior approach needed more radiofrequency pulses , longer procedural time , and longer fluoroscopy exposure time
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 .