Rhythm Control - Catheter Ablation With or Without Anti-arrhythmic Drug Control of Maintaining Sinus Rhythm Versus Rate Control With Medical Therapy and/or Atrio-ventricular Junction Ablation and Pacemaker Treatment for Atrial Fibrillation

Inclusion Criteria

• •1. Patients with one of the following AF categories and at least one ECG documentation of AF
• •* High burden Paroxysmal defined as ≥ 4 episodes of AF in the last 6 months, and at least one episode \> 6 hours (and no episode requiring cardioversion and no episode \> 7 days)
• •* Persistent AF (1) defined as ≥ 4 episodes of AF in the last 6 months, and at least one episode \> 6 hours, and at least one AF episode less than 7 days but requires cardioversion. No AF episodes are \> 7 days
• •* Persistent AF (2) as defined by at least one episode of AF \> 7 days but not \> 1 year
• •* Long term persistent AF defined as an AF episode, at least one year in length and no episodes \> 3 years
• •2. Optimal therapy for heart failure of at least 6 weeks (according to 2009 ACCF/AHA class 1 recommendations).
• •3. HF with NYHA class II or III symptoms with either impaired LV function (LVEF ≤ 45%) as determined by EF assessment within the previous 12 months or preserved LV function (LVEF \> 45%) determined by by EF assessment within the previous 12 months
• •4. NT-pro BNP measures:
• •A) Patient has been hospitalized for Heart Failure\* in the past 9 months, has been discharged AND:
• •i- Is presently in Normal Sinus Rhythm and NT-pro BNP is ≥ 400 pg/mL
• •ii- Is presently in Atrial Fibrillation and NT-pro BNP is ≥ 600 pg/mL
• •OR
• •B) Patient has had no hospitalization for Heart Failure in the past 9 months AND:
• •i- Has had paroxysmal Atrial Fibrillation, is presently in Normal Sinus Rhythm and NT-proBNP is ≥ 600 pg/mL
• •ii- Is presently in Atrial Fibrillation and NT-proBNP is ≥ 900 pg/mL
• •\*Heart Failure Admission is defined as admission to hospital \> 24 hours and received treatment for Heart failure
• •5. Suitable candidate for catheter ablation or rate control therapy for the treatment of AF
• •6. Age ≥18