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 .
Left atrial radiofrequency ablation during mitral valve surgery: a prospective randomized multicentre study (SAFIR).
BACKGROUND R and omized studies evaluating left atrial radiofrequency ablation ( RFA ) in patients with persistent atrial fibrillation undergoing mitral valve surgery are scarce and monocentric . AIM To evaluate the efficacy of left atrial RFA concomitant with mitral valve surgery to restore and maintain sinus rhythm . METHODS The SAFIR is a multicentre , double-blinded , central ly r and omized study involving four university hospitals . Between December 2002 and September 2005 , 43 patients with mitral valve disease and long-st and ing , persistent atrial fibrillation ( duration > 6 months ) were included . We compared valvular surgery alone ( n=22 ) or with left atrial RFA ( n=21 ) . The main endpoint was sinus rhythm at 12 months without recurrence of arrhythmia during follow-up . Secondary endpoints were surgical adverse events , atrial fibrillation relapses , stroke and echocardiographic measurements after three and 12 months ' follow-up . Analyses of the efficacy criteria were performed on an intention-to-treat basis . RESULTS The primary endpoint occurred significantly more often in the RFA group than in the control group ( respectively , 12/21 patients [ 57 % ] vs 1/22 patients [ 4 % ] ; p=0.004 ) . There were more patients with sinus rhythm in the RFA group than in the control group at discharge ( 72.7 % vs 4.8 % ; p<0.005 ) , 3-month follow-up ( 85.7 % vs 23.8 % ; p<0.01 ) and 12-month follow-up ( 95.2 % vs 33.3 % ; p<0.005 ) . The patients in the RFA group had similar rates of postoperative complications and stroke during follow-up as those in the control group . CONCLUSIONS This multicentre study suggests that left atrial RFA is effective and safe in patients with chronic atrial fibrillation and mitral valve disease
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 .