Catheter Ablation for Atrial Fibrillation and Heart Failure

Inclusion Criteria:

- Age 18 years to 80 years

- Clinical diagnosis of CHF based on symptoms (Shortness of breath, fatigue, peripheral
edema)

- Systolic left ventricular dysfunction with ejection fraction 40% or less

- NYHA Class I, II or III heart failure

- Paroxysmal AF(2 or more episodes in one month) that terminate within 7 days:or
persistent AF (more than 7 days or less than 7 days but terminated with pharmacologic
or electrical cardioversion).

- Willing and able to sign informed consent

Exclusion Criteria:

- Previous ablation

- Left atrial size greater than 60mm(parasternal view on transthoracic echocardiogram)

- AF episodes triggered by another uniform arrhythmia(e.g.atrial flutter or atrial
tachycardia)

- Active alcohol or drug abuse, which may be causative of AF

- Severe valvular disease requiring surgical repair

- Myocardial infarction within 6 months of enrollment

- Abnormality that prevents catheter introduction

- Coronary surgical revascularization or other cardiac surgery within 6 months of
enrollment

- Patients in whom heart transplant expected with 6 months

- AF deemed secondary to a transient or correctable cause (e.g.electrolyte imbalance
,trauma,recent surgery,,infection, toxic ingestion or endocrinopathy

- Pregnancy or women of child bearing potential & not on reliable method of birth
control

- Contraindication to Warfarin therapy or other bleeding diathesis

- Participation in another clinical trial

- Inaccessable to follow-up

- Life expectancy of less than 24 months caused by reasons other than heart disease

- Renal failure requiring dialysis

- Decompensated CHF within 48 Hours of enrollment

- Second or third degree AV block or sinus pause greater than 3 seconds, resting heart
rate less 30 bpm without a permanent pacemaker

- A history of drug induced Torsades de Pointes or congenital long QT syndrome

- Currently responding to antiarrhythmic drug therapy

- Uninterrupted AF for more than 12 months prior to randomization unless sinus rhythm
maintained for 24 hours or longer.

- Unwilling or unable to sign informed consent