Danish Evaluation of Early Catheter Ablation for Atrial Fibrillation in Patients With Heart Failure

Inclusion criteria

• HF patients with AF within the past 12 months
• HF is defined as all of the below (all must apply)
• Clinically assessed Heart Failure with Reduced Ejection Fraction (HFrEF)
• An indication for initiation or ongoing guideline directed medical therapy for HFrEF, according to current Heart Failure guidelines
• LVEF \< 50% at any point during the past 12 months
• AF is defined as one or more of the following:
• A. Symptomatic AF, documented by ECG, Holter of CIED
• B. Asymptomatic AF with one or more of the following:
• Clinical indication for rhythm or rate control (documented by ECG, telemetry, Holter, CIED)
• ≥2 ECG detected AF episodes within 3 months (on separate dates)
• Holter detected AF with a continuous duration of more than 6 hours
• CIED detected AF with continuous duration \>24 hours
• 18 years ≤ Age \<80 years
• Optimal medical therapy for HFrEF or planned/current uptitration in guideline directed medical therapy for HFrEF
• Treatment with anticoagulation for stroke prevention, initiated according to guidelines for treatment of AF

Exclusion criteria

• Life-expectancy \< 1 year
• BMI \> 40
• Contraindications or unacceptable side effects to rate limiting drugs AND amiodarone
• LA size (indexed for BSA) \> 60 ml/m2 (volume) on echo within the last year
• Documented persistent/permanent AF \> 1 year
• Previous AF ablation/surgery
• Reversible causes of AF (including, but not limited to, infection within 14 days, untreated thyroid disease, surgery)
• Severe valvular disease
• Acute myocardial infarction, cardiothoracic surgery or stroke within the past 3 months
• Planned cardiothoracic surgery
• Listed for heart transplant
• Contraindications for anticoagulation therapy or catheter ablation
• Severe kidney disease (CKD≥5)
• Pregnancy
• Patient unwilling to try medical therapy for AF
• Patient unwilling/unable to give informed consent for study participation