**9. Conclusion**

In the management of AF in HFrEF, there is insufficient evidence in favor of a strategy of rhythm control with antiarrhythmic drugs vs. rate control in patients with HF and AF. Pharmacological rate control strategy remained as leading option in AF and HF. More evidence is needed to weigh the short-term risks of catheter ablation versus the long-term risks associated with antiarrhythmic therapy in those with AF and HFrEF. Notably, this has led to recent guideline changes suggesting that CA may be considered as first-line therapy in patients with AF and HFrEF (Class I recommendation). Pace and ablate option should be keep as last resort, because this becomes pacemaker-dependent and irreversible. Conduction system pacing as alternative pacing site in AF and HF should be an interesting area to watch in the future. On the other hand, pharmacological approach remained as preferred strategy in HFpEF; non-dihydropyridine calcium-channel blockers are the additional alternative medication compared with HFrEF. Evidence on nonpharmacological approach for AF in HFpEF is still limited.
