Junctional AV Ablation in CRT-D: JAVA-CRT

Inclusion Criteria:

Optimal pharmacologic therapy is defined by published guidelines from the American Heart Association and the American College of Cardiology
Initial implantation of CRT-D or prior implantation of CRT-D within one year
Ischemic or nonischemic cardiomyopathy
LVEF ≤ 35%
NYHA class II-IV (ambulatory)
QRS ≥ 120 ms for LBBB and ≥ 150 ms for non-LBBB patients
Continuous AF > 3 months when no further efforts to restore sinus rhythm are feasible or pursued

Exclusion Criteria:

Ventricular rate > 110 bpm at rest despite maximal medical therapy
Ventricular rate < 50 bpm at rest
Heart block/symptomatic bradycardia that necessitates permanent pacing
Acute coronary syndrome or coronary artery bypass surgery within 12 weeks
Severe aortic or mitral valvular heart disease
Prior AVJ ablation
Any medical condition likely to limit survival to < 1 year
Patients with ACC/AHA Stage D refractory Class IV symptoms listed for transplant or requiring inotropic support
Contraindication to systematic anticoagulation
Renal failure requiring dialysis
AF due to reversible cause e.g. hyperthyroid state
Pregnancy
Participation in other clinical trials that will affect the objectives of this study
History of non-compliance to medical therapy
Inability or unwillingness to provide informed consent
Patients with short-lived AF or those in sinus rhythm are ineligible