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Contemporary management includes rhythm control with AF ablation, or rate control and regularization with conduction system pacing and atrioventricular nodal ablation (CSP + AVNA). These strategies have never been compared in a randomized clinical trial. The study aims to determine whether CSP + AVNA is superior to AF ablation for reducing all-cause mortality and cardiovascular hospitalization, and noninferior with respect to all-cause mortality and heart failure hospitalization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>ABACUS is a multicentre, investigator-initiated, randomized controlled trial enrolling 220 patients with persistent AF and HF, aged &amp;gt;60 years, who are eligible for both treatment modalities, with at most one previous AF ablation procedure. Participants will be randomized 1:1 to either catheter ablation of AF (with pulmonary vein isolation using any routine technique) or to CSP + AVNA. All patients will undergo at least one year of follow-up. The co-primary endpoints will be tested sequentially. A number of predefined secondary endpoints, including costs, will also be evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>ABACUS compares CSP + AVNA with AF ablation in patients with persistent AF and HF. The results will provide evidence to improve care in this vulnerable patient population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjopen\/oeag007","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T12:36:27Z","timestamp":1768566987000},"source":"Crossref","is-referenced-by-count":3,"title":["Catheter Ablation of atrial fibrillation vs. atrioventricular nodal ablation with Conduction system pacing in persistent atrial fibrillation and heart failure (ABACUS): rationale and design"],"prefix":"10.1093","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4393-5338","authenticated-orcid":false,"given":"Haran","family":"Burri","sequence":"first","affiliation":[{"name":"Cardiology Department, University Hospital of Geneva 4 , Rue Gabrielle Perret Gentil, 1211 Geneva 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