Clinical Research Directory

Inclusion Criteria: 1. Patients with atrial fibrillation (AF) where AVNA is being considered with or without a pacemaker 1. Are on optimal heart failure therapies for ≥4 weeks 2. NYHA class I-IVa 2. Patients deemed not appropriate for rhythm control strategy (only for rate control strategy). 1. Failed Ablation (≥1 failed ablation attempt) 2. Refractory or intolerant to Antiarrhythmic drugs AADs or rate control medications 3. Patient choice not to have rhythm control strategies 4. Being considered for AVNA 3. Patients with baseline NT-proBNP\>600 or \>400 if HF hospitalization within 12 months. Exclusion Criteria: 1. In-hospital patients with acute cardiac or non-cardiac illness that requires intensive care 2. Acute coronary syndrome (including MI) or Coronary revascularization (CABG or PCI) \<3 months 3. Uncorrected or uncorrectable primary moderate to severe valvular disease 4. TAVI \< 3 months 5. Restrictive, or reversible form of cardiomyopathy, cardiac amyloidosis 6. Severe primary pulmonary disease such as cor pulmonale, irreversible lung disease requiring inhalers, oxygen supplementation 7. Pulmonary hypertension (Mean pulmonary pressure is ≥35 mm Hg) 8. Patients with a life expectancy of less than one year from non-cardiac cause 9. Patients included in other clinical trials that will affect the objectives of this study or have competing interests 10. Those unable or unwilling to provide informed consent unless supported by legal power of attorney 11. Active malignancy with likelihood of survival \<1 year 12. NYHA class IVb