Optimal Ablation Strategies for Persistent AF With HF

Lab values

• Any of the following criteria shall be excluded.
  • End-Stage Heart Failure: Patients with heart failure classified as NYHA class IV or with LVEF ≤ 20%.
  • Severe Comorbidities:
  • Patients with severe pulmonary disease (e.g., COPD, severe restrictive lung disease).
  • Severe renal dysfunction (eGFR \< 30 mL/min/1.73m²) or advanced liver disease.
  • Active malignancy or other terminal illnesses with a prognosis of less than one year.
  • Inability to Tolerate Ablation:
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  • Patients unable to undergo catheter ablation due to anatomical or procedural issues.
  • Patients with contraindications to the procedure, including allergy to contrast agents or inability to tolerate anesthesia.
  • Left atrial thrombus confirmed by preoperative esophageal ultrasound; 7. Uncontrolled Arrhythmias: Patients with persistent or paroxysmal AF who are unable to maintain sinus rhythm despite optimal medical therapy or require frequent hospitalization for arrhythmia control.
  • 8\. Pregnancy: Pregnant or breastfeeding women. 9. Contraindications to Anticoagulation: 10. Patients who are contraindicated for anticoagulation therapy (e.g., history of major bleeding or bleeding diathesis).
  • 11\. History of Severe Valve Disease: Patients with a history of severe valve disease and/or prosthetic valve replacement.
  • 12\. Recent Myocardial Infarction or Stroke: Patients who have had a myocardial infarction or stroke within the past 3 months.
  • 13\. Contrast Agent Allergy: Patients with a known allergy to contrast agents. 14. Contraindications for Cardiac Catheterization: Any contraindications for cardiac catheterization, including inability to safely perform the procedure.
  • 15\. Atrial Fibrillation Ablation: Patients who have previously undergone atrial fibrillation ablation.
  • 16\. Cardiac Surgery: Patients who have undergone any cardiac surgery within the last 2 months.
  • 17\. Life Expectancy: Patients with a life expectancy of less than 1 year.

• All inclusion criteria must be met to be included in the study.
  • Age: Patients aged 18-80 years, with persistent atrial fibrillation (AF) and heart failure (HF), regardless of ejection fraction (EF).
  • Diagnosis of Heart Failure:
  • Heart Failure with Reduced Ejection Fraction (HFrEF): LVEF ≤ 40%. Heart Failure with Preserved Ejection Fraction (HFpEF): LVEF \> 40%, including HFmrEF (LVEF 41-50%).
  • Symptomatic Atrial Fibrillation: Patients with symptomatic persistent AF who have failed or are intolerant to at least one antiarrhythmic drug.
  • NYHA Class II-III: Patients with heart failure classified as NYHA class II-III, who are symptomatic despite optimal medical therapy. Informed Consent: Able to provide written informed consent for participation in the study.
  • Guideline-Recommended Pharmacologic Therapy: Patients who have received and are currently on guideline-recommended pharmacologic therapy for heart failure, including but not limited to ACE inhibitors, beta-blockers, diuretics, and mineralocorticoid receptor antagonists (MRAs).