Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: A Randomized Ablation-based Atrial Fibrillation Rhythm Control Versus Rate Control Trial in Patients With Heart Failure and High Burden Atrial Fibrillation
Brief Summary: Atrial fibrillation and heart failure are two common heart conditions that are associated with an increase in death and suffering. When both of these two conditions occur in a patient the patient's prognosis is poor. These patients have poor life quality and are frequently admitted to the hospital. The treatment of atrial fibrillation in heart failure patients is extremely challenging. Two options for managing the atrial fibrillation are permitting the atrial fibrillation to continue but controlling the heart rate, or to convert the atrial fibrillation rhythm back to normal and try to maintain the heart in sinus rhythm. Until now, the method to keep the patient in normal sinus rhythm is with antiarrhythmic drugs. Studies using antiarrhythmic drugs to control the rhythm failed to show any survival benefit when compared with permitting the patient to be in atrial fibrillation. In the last few years, new development in techniques and technologies now enable catheter ablation (cauterization of tissue in the heart with a catheter) to be a successful treatment in abolishing atrial fibrillation and that this approach is better than antiarrhythmic drug to control the rhythm. However, there has not been any long-term study to determine whether catheter ablation to abolish atrial fibrillation in heart failure patients would reduce mortality or admissions for heart failure.

This study is to compare the effect of catheter ablation-based atrial fibrillation rhythm control to rate control in patients with heart failure and high burden atrial fibrillation on the composite endpoint of all-cause mortality and heart failure events defined as an admission to a healthcare facility for \> 24 hours or clinically significant worsening heart failure leading to an intervention (defined as treatment in an emergency department, a same-day access clinic, or an infusion centre) or unscheduled visits to a healthcare provider for administration of an intravenous diuretic and an increase in chronic heart failure therapy. This study may have a dramatic impact on the way the investigators manage these patients with atrial fibrillation and heart failure and may improve the outlook and well being of these patients.


Options:
A: Arm Label: Rhythm Control; Type: ACTIVE_COMPARATOR; Interventions: Procedure: Rhythm control | Arm Label: Rate Control; Type: ACTIVE_COMPARATOR; Interventions: Other: Rate Control | Intervention Type: PROCEDURE; Name: Rhythm control; Assigned to Arm(s): Rhythm Control | Intervention Type: OTHER; Name: Rate Control; Assigned to Arm(s): Rate Control
B: Arm Label: PVI + Lines Ablation; Type: EXPERIMENTAL; Interventions: Procedure: PVI + Lines ablation | Arm Label: PVI Ablation; Type: ACTIVE_COMPARATOR; Interventions: Procedure: PVI | Arm Label: PVI + CFE; Type: EXPERIMENTAL; Interventions: Procedure: PVI + CFE ablation | Intervention Type: PROCEDURE; Name: PVI + Lines ablation; Assigned to Arm(s): PVI + Lines Ablation | Intervention Type: PROCEDURE; Name: PVI; Assigned to Arm(s): PVI Ablation | Intervention Type: PROCEDURE; Name: PVI + CFE ablation; Assigned to Arm(s): PVI + CFE
C: Arm Label: Drug Treatment; Type: ACTIVE_COMPARATOR; Interventions: Device: Radiofrequency ablation, antiarrhythmic drugs, Drug: Amiodarone, flecainide, propafenone, quinidine, dofetilide, sotalol, cibenzoline, beta blocking and calcium channel blocking agents and antiarrhythmic drugs | Arm Label: ThermoCool Radiofrequency Catheter; Type: ACTIVE_COMPARATOR; Interventions: Device: Radiofrequency ablation, antiarrhythmic drugs, Device: ThermoCool Radiofrequency Catheter | Intervention Type: DEVICE; Name: Radiofrequency ablation, antiarrhythmic drugs; Assigned to Arm(s): Drug Treatment, ThermoCool Radiofrequency Catheter | Intervention Type: DRUG; Name: Amiodarone, flecainide, propafenone, quinidine, dofetilide, sotalol, cibenzoline, beta blocking and calcium channel blocking agents and antiarrhythmic drugs; Assigned to Arm(s): Drug Treatment | Intervention Type: DEVICE; Name: ThermoCool Radiofrequency Catheter; Assigned to Arm(s): ThermoCool Radiofrequency Catheter
D: Arm Label: medical therapy; Type: ACTIVE_COMPARATOR; Interventions: Drug: ACE inhibitor - ramipril, enalapril, captopril, perindopril, lisinopril, Drug: Beta Blocker (BB) - metoprolol, bisoprolol, carvedilol, Drug: Aldosterone Antagonists - spironolactone | Arm Label: Radiofrequency ablation (RFA); Type: ACTIVE_COMPARATOR; Interventions: Procedure: radiofrequency ablation | Intervention Type: PROCEDURE; Name: radiofrequency ablation; Assigned to Arm(s): Radiofrequency ablation (RFA) | Intervention Type: DRUG; Name: ACE inhibitor - ramipril, enalapril, captopril, perindopril, lisinopril; Assigned to Arm(s): medical therapy | Intervention Type: DRUG; Name: Beta Blocker (BB) - metoprolol, bisoprolol, carvedilol; Assigned to Arm(s): medical therapy | Intervention Type: DRUG; Name: Aldosterone Antagonists - spironolactone; Assigned to Arm(s): medical therapy

Answer: A