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 .
Importance of rate control or rate regulation for improving exercise capacity and quality of life in patients with permanent atrial fibrillation and normal left ventricular function: a randomised controlled study
OBJECTIVE To determine the importance of rhythm regulation or rate control in patients with permanent atrial fibrillation ( AF ) and normal left ventricular function . PATIENTS AND INTERVENTIONS Thirty six patients with a mixed fast and slow ventricular response rate to their AF were  r and omised to either His bundle ablation ( HBA ) and VVIR pacemaker ( HBA group ) or VVI pacemaker and atrioventricular modifying drugs ( Med group ) . Outcomes assessed at one , three , six , and 12 months included exercise duration and quality of life . RESULTS Exercise duration significantly improved from baseline in both groups . There was no difference in outcome between the groups ( Med + 40%v HBA + 20 % , p = NS ) . The heart rate profile on exercise was similarly slowed in both groups compared to baseline . Quality of life significantly improved in both treatment arms for the modified Karolinska question naire ( KQ ) ( Med + 50%v HBA + 50 % , p = NS ) and the Nottingham health profile ( NHP ) ( Med + 40 % v HBA + 20 % , p = NS ) . However , for the individual symptom scores of each question naire more were improved in the Med group ( KQ-Med 6 improvedv HBA 4 , NHP-Med 3 vHBA 1 ) . Left ventricular function was equally preserved by both treatments during follow up . CONCLUSION In these patients control of ventricular response rate with either HBA + VVIR pacemaker or atrioventricular modifying drugs + VVI pacemaker will lead to a significant improvement in exercise duration and quality of life . Rhythm regulation by HBA did not confer additional benefit , suggesting rate control alone is necessary for the successful symptomatic treatment of these patients in permanent AF
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 .