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 .
Randomized comparison between pulmonary vein antral isolation versus complex fractionated electrogram ablation for paroxysmal atrial fibrillation.
INTRODUCTION Circumferential pulmonary vein antral isolation ( PVAI ) and atrial complex fractionated electrograms ( CFEs ) are both ablative techniques for the treatment of paroxysmal atrial fibrillation ( PAF ) . However , data on the comparative value of these 2 ablation strategies are very limited . METHODS AND RESULTS We r and omized 118 patients with drug-refractory PAF to receive  PVAI ablation ( n = 60 ) or CFE ablation ( n = 58 ) . For CFE group , spontaneous/induced AF was mapped using vali date d , automated software to guide ablation until all CFE areas were eliminated . For PVAI group , all 4 pulmonary vein antra were electrically isolated as confirmed by circular mapping catheter . Patients with spontaneous/inducible AF after the initial ablation procedure were crossed over to the other arms . After initial ablation procedure , AF persisted/inducible in 24/59 patients ( 41 % ) , and 34/58 patients ( 59 % ) assigned to PVAI and CFE ablation , respectively ( P = 0.05 ) . Then 58 patients underwent PVAI + CFE ablation . After 22.6 ± 6.4 months , PVAI ablation group was more likely than CFE ablation group to achieve control of any AF/atrial tachycardia ( AT ) off drugs ( 43/60 , 72 % vs 33/58 , 57 % , P = 0.075 ) and lower recurrence rate of AT ( 11.9 % vs 34.5 % , P = 0.004 ) . Patients who received CFE ablation alone ( 38 % ) had significantly lower overall success rate to achieve control of AF/AT off drugs compared with patients who received PVAI ablation ( 77 % , P = 0.002 ) alone or PVAI + CFE ablation ( 69 % , P = 0.008 ) due to higher recurrence rate of AT ( 50 % vs 6 % vs 13 % , P < 0.01 ) . CONCLUSIONS CFE ablation in PAF patients was associated with higher occurrence rate of postprocedure AT compared with PVAI ablation , whereby making it less likely to be a sole ablation strategy for PAF patients
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 .