In what clinical context would you consider offering first time catheter ablation for symptomatic atrial fibrillation in patients with advanced heart failure, as opposed to a trial of antiarrhythmics and/or cardioversion?

I would favor first-time catheter ablation in patients with advanced heart failure as a way to improve LVEF%, symptoms, reduce risk for recurrent hospitalizations, and decrease mortality. Many patients with advanced heart failure have an enlarged LAVI, so DCCV will only be a temporary solution and a...

This is strongly supported by the CASTLE-AF trial.