Atrial Fibrillation Ablation Versus Atrioventricular Nodal Ablation with Conduction System Pacing in Heart Failure

This study compares two procedures in people with persistent irregular heart rhythm (atrial fibrillation) and heart failure: one that burns away the source of the irregular rhythm (AF ablation), and one that blocks the signal between the upper and lower heart chambers while implanting a special pacemaker. The goal is to find out which approach better improves heart failure symptoms. **You may be eligible if...** - You are over 60 with persistent atrial fibrillation and heart failure symptoms despite medication - You have been hospitalized or visited an ER for heart failure in the past 2 years - Your blood has shown elevated heart failure markers (BNP or NT-proBNP) - You have already tried rate or rhythm control medications **You may NOT be eligible if...** - Your heart failure is in the most severe stage (NYHA Class IV with very low blood pressure) - You have a life expectancy of less than 2 years - You have already had more than one prior ablation procedure Talk to your doctor to see if this trial is right for you.