Hybrid Ablation of Atrial Fibrillation in Heart Failure

This study compares two treatment options for people with persistent or long-standing atrial fibrillation (irregular heartbeat) combined with a weakened heart (heart failure with reduced pumping function). It tests whether a combined surgical-plus-catheter ablation approach works better than catheter ablation alone. **You may be eligible if...** - You are 18 or older - You have persistent or long-standing persistent atrial fibrillation - Your left atrium (upper left chamber of the heart) is at least moderately enlarged - Your heart's pumping function (LVEF) is below 50% - You are a suitable candidate for either procedure **You may NOT be eligible if...** - You have not yet had optimal medication or lifestyle changes for your condition - You have had previous open-heart surgery - You have an active infection, esophageal ulcer, or esophageal varices - You have had prior catheter ablation for atrial fibrillation Talk to your doctor to see if this trial is right for you.