Radiofrequency (RF) Ablation for Atrial Fibrillation (AF) in Patients With Heart Failure With Preserved Ejection Fraction

Inclusion Criteria:

Age ≥ 50 years at date of consent.
LVEF >50% as determined on imaging study measured in the last 6 calendar months prior to or on consent date.
Hospitalized for HF within the past 12 calendar months prior to consent date.
Stabilized patients defined as being off all IV therapies for at least 24 hours prior to consent date.
Paroxysmal AF diagnosed within the past 6 calendar months or early persistent AF, defined as an AF episode lasting greater than 7 days but less than 6 calendar months prior to consent date.
Indicated for oral anticoagulation according to current guidelines (CHA2DS2-VASc ≥ 2 in men or ≥ 3 in women at the time of consent)*
Patient with CIED in situ at time of consent or scheduled to undergo ICM implant for AF management within 2 calendar months of randomization.

Exclusion Criteria:

Previous catheter or surgical ablation of AF any time in the past.
Long-standing persistent AF (>1-year prior to consent date) or permanent AF.
Chronic pulmonary disease requiring home oxygen or oral/IV steroid therapy in the past 12 calendar months prior to consent date.
Active infection at time of consent but may be re-considered for enrollment later after effective treatment.
Left atrial size >50 mm as measured by echo in the past 6 calendar months prior to consent date.
Untreated obstructive sleep apnea any time in past.
Myocardial infarction in past 3 calendar months prior to consent date.
Coronary artery bypass graft (CABG) surgery in past 3 calendar months prior to consent date.
Stroke in past 3 calendar months prior to consent date.
Intra-cardiac thrombus precluding ability to undergo AF ablation at time of consent but may be re-considered for enrollment later after effective treatment.
Infiltrative cardiomyopathy (sarcoid, amyloid) any time in past.
Active myocarditis at time of consent but may be re-considered for enrollment later after effective treatment.
Hypertrophic cardiomyopathy at any time in past.
Known pericardial constriction.
Uncontrolled hypertension (SBP > 160 mmHg) at time of consent but may be re- considered for enrollment later after effective treatment.
Untreated hypothyroidism or hyperthyroidism but may be re-considered for enrollment later after effective treatment.
Pregnancy or nursing.
Valvular AF or presence of a prosthetic valve.
Undergoing dialysis or have advanced renal dysfunction (eGFR <30 ml/min/m2) defined as 3 times the upper limits of AST or ALT during the past 6 calendar months.
Contraindication to anticoagulation.
Metabolic derangements (e.g. renal/hepatic failure, electrolyte disturbance, etc.), prohibiting study (EP) study and ablation.
Cognitive impairment.
Life expectancy < 1 year following consent date.
Unwilling to comply with all study protocol-required testing.
Unwilling or unable to give informed consent.