Treating Atrial Fibrillation in Heart Failure With Preserved Ejection Fraction: Ablation or Medication

Who May Qualify: - Age ≥18 years - Diagnosis of atrial fibrillation (documented on Holter, rhythm strip, or ECG) - New York Heart Association (NYHA) class II-III heart failure - Left ventricular ejection fraction (LVEF) \>40% - Meet specific NT-proBNP criteria: - If HF hospitalization within 6 months prior to screening: NT-proBNP \>200 pg/ml (if not in AF at screening) or \>600 pg/ml (if in AF at screening) - Otherwise: NT-proBNP \>300 pg/ml (if not in AF at screening) or \>900 pg/ml (if in AF at screening) - On stable guideline-directed medical therapy for ≥1 month - On stable diuretic dose for ≥2 weeks - Suitable for either ablation-based rhythm control or rate control strategy Who Should NOT Join This Trial: - Permanent atrial fibrillation diagnosis - Prior catheter ablation for atrial fibrillation - NYHA class IV heart failure - Rheumatic heart disease - Moderate or severe mitral stenosis - Mechanical mitral valve - Severe aortic stenosis or severe aortic/mitral regurgitation - Renal failure requiring dialysis - Contraindication to oral anticoagulation - Infiltrative cardiomyopathies - Complex congenital heart disease - Untreated thyroid disease - Acute coronary syndrome or coronary artery bypass surgery within 12 weeks - Participation in another clinical trial - Inability to provide willing to sign a consent form - Other serious non-cardiovascular condition with life expectancy ≤1 year - Age \<18 years Always talk to your doctor about whether this trial is right for you.