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 .
Ablation of atypical atrial flutter guided by the use of concealed entrainment in patients without prior cardiac surgery.
INTRODUCTION Mapping techniques have not been systematic ally evaluated with respect to atypical atrial flutter ( AF ) not involving the inferior vena cava isthmus . The purpose of this study was to assess prospect ively the use of concealed entrainment ( CE ) in mapping of AF and to assess the clinical benefit of ablation of clinical ly relevant atypical AF . METHODS AND RESULTS In seven consecutive patients without prior cardiac surgery presenting with atypical AF , mapping was performed in the right and , if necessary , left atrium . At sites with CE , radiofrequency energy was delivered . In a posthoc analysis , the endocardial activation time , stimulus-flutter wave ( F ) interval , presence of split potentials and diastolic potentials , and postpacing interval were assessed , and effective sites were compared to ineffective sites . A total of 22 forms of atypical AF either could be induced or were present at the time of the study . Eleven of the 13 targeted atypical AFs ( 85 % ) were successfully ablated . The positive predictive value of CE increased from 45 % to 75 % in the presence of matching electrogram-F and stimulus-F intervals or if flutter terminated during entrainment pacing , and to 88 % in the presence of split atrial electrograms or diastolic potentials . During short-term clinical follow-up , none of the patients had recurrence of the ablated AF . However , the majority of patients required either medication for atrial fibrillation or repeated interventions for new forms of AF . CONCLUSION Mapping and ablation of atypical AF is feasible if sites with CE can be identified . However , the clinical benefit of successful ablations in patients with atypical flutter appears to be limited
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 .