**7. Catheter ablation patient selection**

In selecting patients with HF for catheter ablation of AF, the increased risk of major peri-procedural events must be carefully weighed against the potential improvement in systolic function, quality of life, and functional status.

AF ablation can be performed safely and long-term prognosis can improve, especially in patients with a tachycardiomyopathy, that is, without other demonstrable underlying heart disease. Based on the post-hoc analysis of CASTLE-AF, patients with NYHA I/II and non-ischemic etiology of HF appear to benefit the most, suggesting that early intervention might be beneficial [49].

Furthermore, enlargement of the atria and evidence of fibrosis on CMR are an indication of poor candidate for CA. A trial of cardioversion with electrical cardioversion and/or amiodarone can be used if there is a doubt whether patients may benefit from sinus rhythm [11].
