Atrioventricular Node Ablation and Conduction System Pacing in Patients With Well Controlled Permanent Atrial Fibrillation (AF), Heart Failure and Preserved Ejection Fraction: Heart Rate Regularization Versus Medical Rate Control

This trial is comparing two approaches to managing a slow, irregular heartbeat in patients with permanent atrial fibrillation (AF) and heart failure with preserved pump function: one approach uses a procedure to ablate the heart's electrical relay node and implant a pacemaker (conduction system pacing), and the other continues with medications alone to control heart rate. The goal is to see which approach better prevents hospitalizations and improves quality of life. **You may be eligible if...** - You have had permanent atrial fibrillation for more than 6 months - Your heart's pumping function is preserved (ejection fraction at least 50%) - You have been hospitalized at least once in the past year for heart failure - Your heart failure symptoms are moderate (NYHA class 2 or higher) - You have evidence of diastolic heart dysfunction (stiff heart) based on tests - Your heart rate is controlled (average 110 beats/min or lower on a 24-hour monitor) **You may NOT be eligible if...** - You have a wide QRS complex on your ECG - You have structural heart disease beyond what is defined in the study - You are under 18 or lack the legal capacity to consent Talk to your doctor to see if this trial is right for you.