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 .
Does intensity of rate-control influence outcome in atrial fibrillation? An analysis of pooled data from the RACE and AFFIRM studies.
AIMS The AFFIRM and RACE studies showed that rate control is an acceptable treatment strategy for  atrial fibrillation ( AF ) .  We examined whether strict rate control offers benefit over more lenient rate control . METHODS AND RESULTS We compared the outcome of patients enrolled in the rate-control arms of AFFIRM and RACE , using data from patients who met a composite of overlapping inclusion and exclusion criteria . We evaluated 1091 patients , 874 from AFFIRM and 217 from RACE . In AFFIRM , the rate-control strategy aim ed for a resting heart rate < or = 80 bpm and heart rate during daily activity of < or = 110 bpm . In RACE , a more lenient approach was taken : resting heart rate < 100 bpm . Primary endpoint was a composite of mortality , cardiovascular hospitalization , and myocardial infa rct ion . Mean heart rate across all follow-up visits for patients in AF was lower in AFFIRM ( 76.1 vs. 83.4 bpm ) . Event-free survival for the occurrence of the primary endpoint did not differ ( 64 % in AFFIRM vs. 66 % in RACE ) . Patients with mean heart rates during AF within the AFFIRM ( < or = 80 ) or RACE ( < 100 ) criteria had a better outcome than patients with heart rates > or = 100 ( hazard ratios 0.69 and 0.58 , respectively , for < or = 80 and < 100 compared with > or = 100 bpm ) . CONCLUSION Stringency of the approach to rate control , based on the comparison of the AFFIRM and RACE studies , was not associated with an important difference in clinical events
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 .