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 superior pulmonary veins compared to ablation of all four pulmonary veins:.
INTRODUCTION Isolation of all pulmonary veins ( PV ) is advocated for treatment of paroxysmal atrial fibrillation ( PAF ) . However , the superior PVs are responsible for most AF triggers , whereas the inferior PVs carry the higher risk for ablation-induced ostial stenosis . The aim of this study was to compare a superior PV isolation approach with isolation of all PVs for treatment of PAF . METHODS AND RESULTS Fifty-two patients with PAF were r and omized to either left superior pulmonary vein ( LSPV ) isolation followed by additional isolation of the right superior pulmonary vein ( RSPV ) in case of AF recurrence ( group A , n = 27 ) or isolation of all four PVs followed by a repeat procedure in case of recurrence ( group B , n = 25 ) . At 1-year follow-up , 11 patients ( 41 % ) in group A and 8 patients ( 32 % ) in group B had AF relapse ( P = 0.55 ) . No significant differences in AF relapse were detected between groups at 3 and 12 months ( log rank = 0.36 , P = 0.54 ) and by Cox proportional hazards model analysis ( P = 0.62 ) . Nonsignificant PV stenosis was detected in two patients from group B. Total radiofrequency energy delivery and fluoroscopy and procedure times were lower in group A : 8.9 + /- 1.4 minutes vs 25.6 + /- 3.7 minutes ( P < 0.001 ) , 22.2 + /- 6.8 minutes vs 62 + /- 10.3 minutes ( P < 0.001 ) , and 131.8 + /- 26.5 minutes vs 222.2 + /- 32.3 minutes ( P < 0.001 ) , respectively . CONCLUSION A staged superior PVs isolation approach confers equal success rates but with reduced radiofrequency energy delivery and fluoroscopy and procedure times compared to isolation of all PVs at the initial ablation attempt
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 .