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Background  Atrial fibrillation ( AF ) and heart failure with reduced ejection fraction frequently coexist. The AATAC (Ablation versus Amiodarone for Treatment of persistent Atrial fibrillation in patients with Congestive heart failure and an implantable device) trial suggests that catheter ablation may benefit these patients. However, applicability to contemporary ambulatory cardiology practice is unknown.    Methods and Results  Using the outpatient National Cardiovascular Data Registry ®  Practice Innovation and Clinical Excellence Registry, we identified participants meeting  AATAC  enrollment criteria between 2013 and 2014. Treatment with medications and procedures was assessed at registry inclusion. From 164 166 patients with  AF  and heart failure, 8483 (7%) patients potentially met  AATAC  inclusion criteria. Eligible subjects, compared to  AATAC  trial participants, were older (mean age, 71.2±11.4 years) and had greater comorbidity (coronary artery disease 79.2%, hypertension 82.4%, and diabetes mellitus 31.8%).  AF  was predominantly paroxysmal (65.5%), rather than persistent/permanent (16.7%) or new onset (17.8%), whereas all patients in the  AATAC  trial had persistent  AF . Commonly used atrioventricular‐nodal blocking agents were carvedilol (71.2%), digoxin (31.9%), and metoprolol (27.1%). Rhythm control with anti‐arrhythmic drugs was reported in 29.0% of  AATAC  eligible patients (predominantly amiodarone [24.6%]) and 9.3% had undergone catheter ablation. Patients who underwent ablation were more likely to be younger and have less comorbidities than those who did not.    Conclusions  Among the contemporary ambulatory AF/heart failure with reduced ejection fraction population, treatment is predominantly rate control with few catheter ablations. Application of  AATAC  findings has the potential to markedly increase the use of catheter ablation in this population, although significant differences in clinical profiles might influence ablation outcomes in practice.

journal of the american heart association

Atrial Fibrillation in Heart Failure  US  Ambulatory Cardiology Practices and the Potential for Uptake of Catheter Ablation: An  National Cardiovascular Data Registry (NCDR  ® ) Research to Practice (R2P) Project