Atrioventricular Node Ablation and Conduction System Pacing in Patients With Well Controlled Permanent Atrial Fibrillation (AF), Heart Failure and Preserved Ejection Fraction: Heart Rate Regularization Versus Medical Rate Control

This study is for people who have two heart conditions: permanent atrial fibrillation and a type of heart failure called heart failure with preserved ejection fraction (often shortened to HFpEF). Atrial fibrillation means your heart beats irregularly and often too fast. HFpEF means your heart muscle still pumps blood out strongly, but it has become stiff and doesn’t relax properly to fill with enough blood.

Currently, many people with these conditions are treated with medicines to control their heart rate. However, researchers are exploring if a different approach might be more effective. This study will look at a treatment that involves two parts: first, a procedure called AV node ablation, which uses controlled heat to create a small block in an electrical pathway in your heart. This helps the heart beat more regularly. Second, a special type of pacemaker is then fitted. A pacemaker is a small device placed under the skin near your collarbone that sends electrical signals to your heart to keep it beating at a regular rhythm. The aim of having a pacemaker after the ablation is to make sure your heart gets a regular, healthy beat, preventing the irregular beats of atrial fibrillation from affecting the rest of your heart.

The main question this study wants to answer is whether combining AV node ablation with this special pacemaker can reduce serious health problems like death or needing to go to the hospital because of your heart failure, compared to just taking your usual medications. Heart failure, particularly HFpEF, is a common and serious condition, and finding better ways to manage it, especially when atrial fibrillation is also present, is very important for patients' well-being.