Treating Atrial Fibrillation in Heart Failure With Preserved Ejection Fraction: Ablation or Medication

Inclusion Criteria: * Age ≥18 years * Diagnosis of atrial fibrillation (documented on Holter, rhythm strip, or ECG) * New York Heart Association (NYHA) class II-III heart failure * Left ventricular ejection fraction (LVEF) \>40% * Meet specific NT-proBNP criteria: * If HF hospitalization within 6 months prior to screening: NT-proBNP \>200 pg/ml (if not in AF at screening) or \>600 pg/ml (if in AF at screening) * Otherwise: NT-proBNP \>300 pg/ml (if not in AF at screening) or \>900 pg/ml (if in AF at screening) * On stable guideline-directed medical therapy for ≥1 month * On stable diuretic dose for ≥2 weeks * Suitable for either ablation-based rhythm control or rate control strategy Exclusion Criteria: * Permanent atrial fibrillation diagnosis * Prior catheter ablation for atrial fibrillation * NYHA class IV heart failure * Rheumatic heart disease * Moderate or severe mitral stenosis * Mechanical mitral valve * Severe aortic stenosis or severe aortic/mitral regurgitation * Renal failure requiring dialysis * Contraindication to oral anticoagulation * Infiltrative cardiomyopathies * Complex congenital heart disease * Untreated thyroid disease * Acute coronary syndrome or coronary artery bypass surgery within 12 weeks * Participation in another clinical trial * Inability to provide informed consent * Other serious non-cardiovascular condition with life expectancy ≤1 year * Age \<18 years