Resync-AF (Rate vs Rhythm Control in AF Patients With CRT-D)

Inclusion Criteria: * Having persistent AF, defined as AF that does not self terminate for at least 24 consecutive hours. * In AF upon entry into the operating room for CRT-D implantation and AV node ablation. * Being on a stable dosage of an ACE inhibitor or ARB for at least 1 month preceding implant * Being on a Beta-blocker for at least 3 months preceding implant and a stable dosage within 1 month of implant * Not taking or able to be taken off all type I/III antiarrhythmic medications. * Taking Coumadin so as to maintain an INR of between 2 and 3. * A Class I or IIa ICD indication * NYHA Class III/IV within 1 month of baseline * Intrinsic QRS duration ≥ 130 ms within 1 month prior to baseline * Left ventricular ejection fraction ≤ 35% (method per physician discretion) within 1 month prior to baseline * Left ventricular end diastolic dimension (LVEDD) ≥ 55 mm (method per physician discretion) within 1 months prior to baseline * Willing to provide written informed consent * Are expected to survive for 6 month of study participation * Able to tolerate an urgent thoracotomy * Able to tolerate \< 1 mg dexamethasone sodium phosphate (steroid) Exclusion Criteria: * Having self-terminating or interminable AF * Having unstable angina, or having experienced an acute myocardial infarction (MI) or received coronary artery revascularization (CABG) or coronary angioplasty (PTCA) within the past 1 month * Post-heart transplant (patients on heart transplant list for the first time are…