The purpose of this study is to investigate whether in patients with early persistent atrial fibrillation and mild to moderate early heart failure an aggressive upstream rhythm control approach, including aldosterone receptor antagonists and statins, dietary restrictions, counseling and cardiac rehabilitation programs, increases persistence of sinus rhythm compared with conventional rhythm control after one year of follow-up.

A randomized long term extension of the RACE 3 will be performed with a total follow-up of 5 years to investigate the long term effects on persistence of sinus rhythm and cardiovascular morbidity and mortality of the two treatment strategies.

Inclusion Criteria:

• Early symptomatic persistent atrial fibrillation
• Mild to moderate early heart failure
• Optimal documentation and treatment of underlying heart disease
• No contra-indication for oral anticoagulation
• Eligible for cardiovascular rehabilitation
• Age >= 40 years

Exclusion Criteria:

• On waiting list for pulmonary vein isolation or expected to be placed on waiting list within one year
• Heart failure NYHA class IV
• LVEF < 25%
• Left atrial size > 50 mm (parasternal axis)
• Present aldosterone receptor antagonist use
• Previous use of class I or III antiarrhythmic drugs (except for sotalol, which should be discontinued at inclusion and replaced with betablocker)
• Cardiac resynchronization therapy