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 .
The Australian Intervention Randomized Control of Rate in Atrial Fibrillation Trial (AIRCRAFT).
OBJECTIVES The Australian Intervention R and omized Control of Rate in Atrial Fibrillation Trial was a multicenter trial of atrioventricular junction ablation and pacing ( AVJAP ) compared with pharmacologic ventricular rate control ( medication [ MED ] ) in patients with mild to moderately symptomatic permanent atrial fibrillation ( AF ) . BACKGROUND There have been very few prospect i ve r and omized trials , undertaken in highly symptomatic patients , comparing AVJAP with pharmacologic methods of ventricular rate control for patients with permanent AF . METHODS There were 99 patients ( 70 men , mean age 68 + /- 8.6 years ) at five centers . Forty-nine patients were r and omized to AVJAP while 50 patients were r and omized to pharmacologic control . The primary end point was cardiac function measured by echocardiography and exercise tolerance . The secondary end points were ventricular rate control , evaluated by 24-h ambulatory electrocardiographic monitoring , and quality of life . Data were collected at r and omization and then at one month , six months , and 12 months post-r and omization . RESULTS At 12 months follow-up there was no significant difference in left ventricular ejection fraction ( AVJAP : 54 + /- 17 % ; MED : 61 + /- 13 % [ p = ns ] ) or exercise duration on treadmill testing ( AVJAP : 4.1 + /- 2 min ; MED : 4.6 + /- 2 min [ p = ns ] ) ; however , the peak ventricular rate was lower in the AVJAP group during exercise ( 112 + /- 17 beats/min vs. 153 + /- 36 beats/min , p < 0.05 ) and activities of daily life ( 117 + /- 16 beats/min vs. 152 + /- 37 beats/min , p < 0.05 ) . The CAST quality -of-life question naire revealed that patients in the AVJAP group had fewer symptoms at six months ( p = 0.003 ) and at 12 months ( p = 0.004 ) . The observed relative risk reduction in symptoms at 12 months was 18 % . Global subjective semiquantitative measurement of quality of life using the " ladder of life " revealed that the AVJAP group reported a 6 % better quality of life at six months ( p = 0.011 ) . CONCLUSIONS In this trial , AVJAP for patients with mild to moderately symptomatic permanent AF did not worsen cardiac function during long-term follow-up , and quality of life was improved
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 .