How should a patient with atrial fibrillation combined with heart failure be treated, first for atrial fibrillation or first for heart failure? It depends on what the cause of the heart failure is. For example, if the heart failure is caused by an ischemic disease (such as myocardial infarction), then the blood vessels need to be opened to allow the heart muscle to receive blood supply so that the symptoms of heart failure can be improved. If the heart failure is caused by rheumatic heart valve disease, the patient needs to be evaluated for valve replacement or valve expansion. If the heart failure is caused by rapid ventricular rate after atrial fibrillation, the heart failure can be controlled by treating atrial fibrillation and restoring sinus rhythm or controlling ventricular rate. If the heart failure is caused by atrial fibrillation, can such a patient undergo catheter ablation? After evaluating the type of atrial fibrillation, heart failure due to atrial fibrillation can be considered for catheter radiofrequency ablation. What tests are needed to assess whether a patient with atrial fibrillation in combination with heart failure can undergo the procedure? The primary disease and the benefit of atrial fibrillation can be assessed through cardiac function tests and cardiac function grading, and of course, whether the patient is in acute heart failure. In general, surgery is not indicated in patients with acute heart failure and is not an option until the patient’s condition has stabilized. Can surgery be performed if the patient has significant atrial hypertrophy and severe fibrosis? Most domestic electrophysiology-related experts believe that catheter ablation can generally be done in patients with anterior and posterior left atrial diameters less than 55 mm. Although the degree of fibrosis can be assessed by MRI or other staining methods in foreign countries, these techniques are not yet available in China. Therefore, at this time, the extent of fibrosis can generally only be evaluated intraoperatively and predicted based on the underlying disease and the size of the atrium. If a patient chooses to undergo catheter ablation, do they need to stop taking their heart failure medication before the procedure? In most cases, heart failure medications do not need to be stopped, but anti-arrhythmic medications do need to be stopped.