Treatment Of Atrial Fibrillation In Preserved Cardiac Function Heart Failure

Inclusion Criteria: Patient with symptomatic Heart Failure with preserved systolic cardiac function & paroxysmal or persistent atrial fibrillation who meet the following criteria

1. Subjects must be willing and able to give written informed consent

2. Outpatients ≥ 50 years of age, male or post- menopausal female patients;premenopausal female patients who are on and will maintain continuous birth controltherapy during the study.

3. Subjects must have documented HFpEF & paroxysmal or persistent AF and satisfy one ofthe following inclusion criteria a) Consecutive patients with AF, symptomatic heartfailure requiring diuretic therapy for at least 30 days prior to study entry b)Hospitalization for HF and/or AF in the past 12 months prior to catheter ablationwith documented NT-pro BNP >200pg/ml for patients not in AF or > 600 pg/ml forpatients in AF on screening ECG or NYHA class 2, 3 or ambulatory class 4 heartfailure documented NT-pro BNP >300pg/ml for patients not in AF or > 900 pg/ml forpatients in AF on screening ECG c).Evidence of structural heart disease defined asby at least 1 of the following echocardiography findings (any local measurement madeduring the screening epoch or within the 6 months prior to screening visit): 1) LAenlargement defined by at least 1 of the following: LA width (diameter) >3.8 cm orLA length >5.0 cm or LA area >20 cm2 or LA volume >55 ml or LA volume index >29ml/m2 2) LVH defined by septal thickness or posterior wall thickness >1.1 cm d).Leftventricular ejection fraction > 45% using standard imaging techniques at enrollmentfor study or in prior 6 months e).ECG documented paroxysmal or persistent atrialfibrillation f).Patients are candidates for a clinically indicated catheter ablationprocedure, and Rate or Rhythm control antiarrhythmic drug therapy

4. Patients should be on one or more standard heart failure drug therapy (ies) forheart failure with preserved cardiac function for at least 30 days

5. Written informed consent for the clinically indicated study procedures

6. Patients must be candidates for long-term OAC therapy based on clinical practiceguidelines for treatment of AF. Guidelines for GFR as established for DOACSs will beapplicable to all subjects.

Exclusion Criteria:

1. Patients with HFpEF who were not on any drug therapy for HF or have uncontrolledhypertension defined as systolic BP >180 mm Hg at screening or >150 mm Hg on threeor more antihypertensive drugs

2. Patients with QRS duration of >120 ms and intraventricular conduction defects whoare or maybe candidates for or have received ventricular resynchronization therapy

3. Recent (<1 month) myocardial infarction or acute coronary syndrome

4. Recent (<3 months) coronary revascularization procedures

5. Documented LA thrombus on TEE or any LVEF measurement <40%

6. Patients who are not candidates for Rate or Rhythm control drug therapy for AF

7. Dilated cardiomyopathy due to potentially reversible cause e.g. myocarditis

8. Contraindications to anticoagulant therapy or adverse event with prior Warfarin orDOAC therapy

9. Creatinine clearance <30ml/min or >95ml/min

10. Advanced hepatic disease, pulmonary disease clinically significant congenital heartdisease, clinically significant pericardial constriction, hypertrophiccardiomyopathy, infiltrative cardiomyopathy, decompensated valvular heart diseaselikely to require surgical or percutaneous intervention during the trial

11. Recent stroke (<3 months) or thromboembolic event, transient ischemic attack orcarotid angioplasty in the prior 3 months

12. Recent (<3 months) intracranial or other major bleeding event

13. Candidates for heart or any other organ transplantation or left ventricular assistdevices, recent (< 3 months) valve or other cardiac surgery

14. Patients requiring ACE inhibitor or ARB drug therapy for any reason

15. History of hypersensitivity to antiarrhythmic drugs

16. Patients with other clinically significant medical condition that precludes studyparticipation

17. Patients with life expectancy < 1 year

18. Premenopausal female patients, who are not on continuous birth control therapy orare likely to discontinue it at any time during the entire duration of studyenrollment.

19. Pregnant or nursing lactating mothers or women of childbearing potential who are noton effective contraceptive therapy

20. Patients who have been noncompliant with medical regimens or have social or otherissues precluding regular follow up, history of alcohol or drug abuse in past 12months.