Double heart fix: could adding valve repair to ablation beat ablation alone?

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: * Age ≥ 18 years * Left ventricular ejection fraction ≥ 50% * Grading of MR: 3+ or 4+ (effective regurgitant orifice area≥30mm2, regurgitant volume ≥45ml) * Valve morphology: MR originating from the mid portion of the valve; mitral valve area\> 4 cm2; Length of posterior leaflet ≥10 mm; Sufficient leaflet tissue for mechanical coaptation: coaptation depth\< 11 mm, coaptation length\> 2 mm * Rate control in suspected AF-induced cardiomyopathy (heart rate \<80 bpm at rest and \<110 bpm during exercise) * Patients must be willing to comply with all follow-up requirements Exclusion Criteria: * Life expectancy\< 1 year due to non-cardiac conditions * Primary mitral regurgitation: valve abnormalities including leaflet tethering from LV dysfunction, intrinsic leaflet pathology (prolapse, flail, calcification, severe thickening), mitral annular calcification (either severe or \<severe but extending into the leaflets), and/or any mixed pathology * Active endocarditis of the mitral valve or rheumatic mitral valve disease * Hypotension (systolic pressure \< 90 mmHg) or requirement for inotropic support or mechanical hemodynamic support * Severe tricuspid regurgitation; Physical evidence of right-sided congestive heart failure with echocardiographic evidence of severe right ventricular dysfunction; Fixed pulmonary artery systolic pressure\> 70 mmHg * Stroke/TIA, TAVR, CRT/ CRT-D/ ICD, cardiac intervention or surgery within 30 days before randomization * Any prior MV surgery or transcatheter procedure * Need for any cardiac surgery (other than for MV disease) * Untreated clinically significant coronary artery disease * Echocardiographic evidence of intracardiac thrombus * Active infections requiring current antibiotic therapy * Patients who cannot tolerate anti-platelet/anticoagulation agents/contrast media * Pregnancy * Any condition making it unlikely the patient will be able to complete all protocol procedures (including compliance with medical therapy) and follow-up visits * Patient (or legal guardian) unable or unwilling to provide written informed consent before study enrollment