Who benefit most from catheter ablation of persistent atrial fibrillation?

Atrial fibrillation (AF) and heart failure (HF) frequently coexist and are associated with common etiologies such as hypertension, diabetes mellitus, coronary heart disease, valvular disease, and sleep apnea. Both AF and HF affect each other negatively. AF may cause impaired left ventricular (LV) systolic function (1) and increase the incidence of HF by three fold (2). It is therefore expected that restoration of sinus rhythm should be associated with improvement of cardiac function and consequently better prognosis. However, previous studies have shown that pharmacological rhythm control strategy is not superior to rate control (3,4), due to limited efficacy to sinus rhythm restoration and potential toxicity of antiarrhythmic drugs