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CRT is established standard pacing strategy.",[18],"Procedure: Cardiac resynchronization therapy",[20,26],{"type":21,"name":22,"description":23,"armGroupLabels":24,"otherNames":25},"PROCEDURE","Conduction System Pacing","The implantation of a pacing device with a pacing lead that aims to capture and pace the native conduction system.",[9],null,{"type":21,"name":27,"description":28,"armGroupLabels":29,"otherNames":25},"Cardiac resynchronization therapy","The implantation of a pacing device with a pacing leads that aims to capture and pace both ventricles in a synchronized fashion, to achieve the best possible hemodynamic parameters and synchrony.",[14],[31,35],{"name":32,"affiliation":33,"role":34},"Michiel Rienstra, MD, PhD, MHA, Professor","University Medical Center Groningen, Groningen, The Netherlands","STUDY_CHAIR",{"name":36,"affiliation":5,"role":37},"Yuri Blaauw, MD, 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Maria Nuova","Reggio Emilia",{"type":53,"coordinates":240},[241,242],10.63125,44.69825,{"lat":242,"lon":241},[245],{"name":246,"role":40,"phone":25,"phoneExt":25,"email":247},"Matteo Iori, MD","Matteo.Iori@ausl.re.it",{"facility":249,"status":25,"city":250,"state":25,"zip":25,"country":180,"countryCode":181,"cosmosGeoPoint":251,"geoPoint":255,"contacts":256},"Ospedale San Pietro Fatebenefratelli","Roma",{"type":53,"coordinates":252},[253,254],11.10642,44.99364,{"lat":254,"lon":253},[257],{"name":258,"role":40,"phone":25,"phoneExt":25,"email":259},"Daniele Porcelli, MD","daniele.porcelli@hotmail.it",{"facility":261,"status":25,"city":262,"state":25,"zip":25,"country":180,"countryCode":181,"cosmosGeoPoint":263,"geoPoint":267,"contacts":268},"Department of Cardiology, Ospedale Panico","Tricase",{"type":53,"coordinates":264},[265,266],18.35421,39.93018,{"lat":266,"lon":265},[269],{"name":270,"role":40,"phone":25,"phoneExt":25,"email":271},"Pietro Palmisano, MD","dr.palmisano@libero.it",{"facility":5,"status":25,"city":273,"state":274,"zip":25,"country":275,"countryCode":276,"cosmosGeoPoint":277,"geoPoint":281,"contacts":282},"Groningen","Provincie Groningen","Netherlands","NL",{"type":53,"coordinates":278},[279,280],6.56667,53.21917,{"lat":280,"lon":279},[283,284],{"name":32,"role":40,"phone":41,"phoneExt":25,"email":42},{"name":36,"role":37,"phone":25,"phoneExt":25,"email":25},{"facility":286,"status":25,"city":287,"state":25,"zip":25,"country":275,"countryCode":276,"cosmosGeoPoint":288,"geoPoint":292,"contacts":293},"Jeroen Bosch Ziekenhuis","'s-Hertogenbosch",{"type":53,"coordinates":289},[290,291],5.30417,51.69917,{"lat":291,"lon":290},[294],{"name":295,"role":40,"phone":25,"phoneExt":25,"email":296},"Wouter Wieringa, MD","w.wieringa@jbz.nl",{"facility":298,"status":25,"city":299,"state":25,"zip":25,"country":275,"countryCode":276,"cosmosGeoPoint":300,"geoPoint":304,"contacts":305},"FrisiusMC","Leeuwarden",{"type":53,"coordinates":301},[302,303],5.80973,53.20271,{"lat":303,"lon":302},[306],{"name":307,"role":40,"phone":25,"phoneExt":25,"email":308},"Marnix Van Bemmel, MD","marnixvanbemmel@outlook.com",{"facility":310,"status":25,"city":311,"state":25,"zip":25,"country":275,"countryCode":276,"cosmosGeoPoint":312,"geoPoint":316,"contacts":317},"Maastricht UMC","Maastricht",{"type":53,"coordinates":313},[314,315],5.68889,50.84833,{"lat":315,"lon":314},[318],{"name":319,"role":40,"phone":25,"phoneExt":25,"email":320},"Twan Van Stipdonk, MD","twan.van.stipdonk@mumc.nl",{"facility":322,"status":25,"city":323,"state":25,"zip":25,"country":275,"countryCode":276,"cosmosGeoPoint":324,"geoPoint":328,"contacts":329},"Antonius Hospital","Nieuwegein",{"type":53,"coordinates":325},[326,327],5.08056,52.02917,{"lat":327,"lon":326},[330],{"name":331,"role":40,"phone":25,"phoneExt":25,"email":332},"Vincent Van Dijk, MD","v.van.dijk@antoniusziekenhuis.nl",{"type":37,"investigatorFullName":334,"investigatorTitle":335,"investigatorAffiliation":5,"oldNameTitle":25,"oldOrganization":25},"M. Rienstra","MD, PhD, MHA, Professor of Clinical Cardiology","100638160","av-nodal-ablation-with-conduction-system-pacing-versus-cardiac-resynchronization-for-symptomatic-heart-failure-patients-with-atrial-fibrillation-100638160",false,"NCT07604727","AV Nodal Ablation With Conduction System Pacing Versus Cardiac Resynchronization for Symptomatic Heart Failure Patients With Atrial Fibrillation","AV Nodal Ablation With Conduction System Pacing Versus Cardiac Resynchronization for Symptomatic Heart Failure Patients With Atrial Fibrillation: The APAF-CSP All-cause Mortality and Quality of Life Trial","APAF-CSP","Inclusion Criteria:\n\n* Age 18 years or above.\n* Patient is diagnosed with AF and deemed not amenable to rhythm control. This diagnosis of AF will be demonstrated by at least one Electrocardiograph (ECG) showing AF that was performed within one year prior to enrollment.\n* Has history of stable heart failure (regardless left ventricular ejection fraction) and has a history of at least one HF related hospitalization or emergency room\u002Furgent care visit within 2 years prior to enrollment, despite being on maximally tolerable guideline directed medical therapy.\n* Willing and capable to provide informed consent.\n\nExclusion Criteria:\n\n* NYHA functional class IV.\n* Severe concomitant non-cardiac disease.\n* Patient who require any cardiac surgical intervention.\n* Previously implanted pacing devices (pacemaker\u002FICD\u002FCRT) with ≥40% pacing burden.\n* Any of the following within the 3 months prior to enrollment:\n\n  * Myocardial infarction\n  * Unstable angina\n  * Percutaneous coronary intervention\n  * Stroke or TIA\n  * Significant bleeding\n  * Pericarditis\u002Feffusions\n* Coronary artery bypass surgery\u002Fatriotomy within 6 months prior to enrolment.\n* Women who are pregnant or breastfeeding.","ALL","18 Years",{"count":347,"type":348},292,"ESTIMATED","INTERVENTIONAL",[351],"NA","The goal of this clinical trial is to learn if conduction system pacing works as well as cardiac resynchronization therapy (CRT) post atrioventricular (AV) node ablation in adult patients with symptomatic heart failure and atrial fibrillation that is not suitable for rhythm control.\n\nThe main question it aims to answer is:\n\nIs AV node ablation with conduction system pacing noninferior to AV node ablation with CRT for the hierarchical composite outcome of all-cause mortality, heart failure hospitalization or urgent heart failure visit, and meaningful improvement in heart failure-related quality of life?\n\nParticipants will undergo:\n\n* An AV node ablation and be randomly assigned to receive either a conduction system pacing or a CRT.\n* Attend follow-up visits (in clinic or by telephone) at baseline, intervention day, 3-month, 12-month, 24-month, and 36-month after the procedure.\n* Complete questionnaires about heart failure symptoms and quality of life at baseline, 12 months, and yearly.\n* Have an echocardiogram, an electrocardiogram, and blood tests at baseline and 1 year\n* At selected centers: they will be asked to wear a bracelet that measures arterial stiffness for 30 minutes and provide a urine sample at baseline and 1 year.",[354,355,356],"Atrial Fibrillation (AF)","Heart Failure","Cardiac Pacing",[22,358,359,360,355,361,362,363,364,365,366,342,367,368,369],"Cardiac Resynchronization","Atrial Fibrillation","AV Nodal Ablation","All-cause Mortality","Quality of Life","HF hospitalization","Unplanned\u002Furgent HF visit","Arterial Stiffness Index","Photoplethysmography","EQ-5D","AFEQT","Kansas City Cardiomyopathy Questionnaire (KCCQ)","NOT_YET_RECRUITING","2026-05-19",{"date":373,"type":374},"2026-05-22","ACTUAL",{"date":376,"type":348},"2026-07",{"date":378,"type":348},"2030-06",{"name":5,"class":6},23]