Atrial Fibrillation Ablation Versus Atrioventricular Nodal Ablation with Conduction System Pacing in Heart Failure

To be considered for this study, you would need to be over 60 years old and have been diagnosed with long-lasting atrial fibrillation (AF) and heart failure that still causes symptoms, even with medication. You might also have been in hospital or visited a clinic for heart failure within the last two years, and blood tests would show certain levels related to heart strain.

You would also need to have tried some medication to control your heart rate or rhythm before. Crucially, the doctors must believe that you are a suitable candidate for the atrial fibrillation ablation procedure, and you should not have had more than one of these procedures in the past.

There are also reasons why you wouldn't be able to join. For example, if your heart failure is very severe (NYHA Class IV) with very low blood pressure, or if doctors believe you have less than two years to live, you wouldn't be suitable. You also can't participate if you need major surgery, have had a heart attack, stroke, or certain heart procedures in the last three months, or if you already have a special type of pacemaker (CRT device). Participating in another clinical trial or being unable to give informed consent would also exclude you.

If you join this study, you will be randomly assigned to receive one of the two treatment options: either a pacemaker with a special procedure (conduction system pacing plus AV nodal ablation) or another heart procedure (atrial fibrillation ablation). The study involves several visits to the hospital for procedures and follow-up checks. You will continue to take your regular heart medications as advised by your doctor. Researchers will closely monitor your health, including performing tests and reviewing your medical records, to see how each treatment works for you. The total study duration for each patient will be about four years, involving regular contact with the study team during this time.