Atrial Fibrillation with Heart Failure with Preserved Ejection Fraction: Treatment Strategies-Catheter Ablation Vs. Anti-Atrial Arrhythmia Drugs

Inclusion Criteria:

• Age ≥18 years.

• The patient is willing and able to comply with the protocol and has provided writteninformed consent.

• Paroxysmal or persistent atrial fibrillation (AF).（Persistent AF was defined as AFwhich is sustained beyond 7 days, or lasting less than seven days but necessitatingpharmacologic or electric cardioversion. Included within the category of persistentAF is 'long-standing persistent AF', defined as continuous AF of >1-year duration.AF episodes had to be documented in the last 3 months prior to enrollment by ECG,Holter ECG, Loop Recorder, memory of the implanted device (ICD/CRT-D), or any othersuitable device.）

• Failure or intolerance of antiarrhythmic drug therapy or unwillingness to takeantiarrhythmic drugs.

• Diagnosed with Heart Failure with Preserved Ejection Fraction (HFpEF).（(1) a historyof hospitalization for HF with symptoms classified as New York Heart Association (NYHA) class II, III, or IV; (2) LVEF ≥ 50%; (3) at least one of the followingcardiac structural abnormalities identified by echocardiography: left ventricularhypertrophy, left atrial enlargement, or diastolic dysfunction; and (4) elevatedlevels of N-terminal pro-brain natriuretic peptide (NT-proBNP), with a threshold of ≥400 pg/mL for pa-tients with SR at admission and ≥600 pg/mL for patients with AF atadmis-sion.)

• New York Heart Association class II, III, or IV.

Exclusion Criteria:

• Previous left heart ablation procedure for AF.

• Contraindication to chronic anticoagulation therapy or heparin.

• Documented left atrial diameter >6 cm, optimally from the parasternal long-axisview.

• Acute coronary syndrome, cardiac surgery, angioplasty, or cerebrovascular accidentwithin 2 months prior to enrollment.

• Planned cardiovascular intervention.

• Listed for heart transplant.

• Cardiac assist device implanted.

• Life expectancy ≤ 12 months.

• Mental or physical inability to participate in the study.

• Requirement for dialysis due to terminal renal failure.

• Woman currently pregnant or breastfeeding or not using reliable contraceptivemeasures during fertility age.

• Enrollment in another investigational drug or device study, or participation inanother telemonitoring concept.