Pacing of Left Bundle Branch Area and Atroventricular Node ablatIon in Patients With Symptomatic Atrial Fibrillation

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• Inclusion:
• Patients who meet all of the following inclusion criteria 1)-6).
• Permanent atrial fibrillation
• Age ≥ 65 years
• Refractory or intolerant to antiarrhythmic drugs, rate control medications, or catheter ablation
• New York Heart Association (NYHA) functional class II- IV
• LVEF > 40% (within the past 3 months)
• Patients with at least one of the following:
  • HF hospitalization (defined as HF as the major reason for hospitalization or treatment for HF lasting ≥12 hours and including treatment with intravenous (IV) diuretics at a healthcare facility) within 12 months
  • Elevated NT-proBNP (>900 pg/ml) in the 30 days prior to enrollment
  • Exclusion:
  • Patients who meet at least one of the following exclusion criteria 1)-11).
• Asymptomatic atrial fibrillation
• Life expectancy to < 12 months.
• Primary moderate to severe valvular disease (except for functional mitral valve regurgitation or tricuspid valve regurgitation)
• Mechanical tricuspid valve replacement
• Severe chronic kidney disease (estimated Glomerular Filtration Rate ≤ 15 ml/1,73 m2 or receiving renal replacement treatment including hemodialysis or peritoneal dialysis)
• Obstructive hypertrophic cardiomyopathy
• Infiltrative cardiomyopathy (amyloidosis, sarcoidosis, Fabry disease, others)
• Acute coronary syndrome or coronary revascularization (CABG or PCI) <3 months
• Severe primary pulmonary disease such as cor pulmonale, irreversible lung disease requiring inhalers, oxygen supplementation
• Pacemaker/ICD/CRT treatment ongoing, or current pacemaker indication
• Simultaneous participation in a different randomized clinical trial