Ablation vs Amiodarone for Treatment of AFib in Patients With CHF and an ICD

Inclusion Criteria: 1. Patients with an dual chamber ICD or CRTD (with an existing functional atrial lead) with remote monitoring capabilities and EF \<= 40% within the last 3 months by echocardiogram, nuclear imaging, MRI or cardiac catheterization, 2. Persistent or chronic symptomatic AF resistant to anti-arrhythmic medication other than Amiodarone. Resistant defined as recurrent AF of greater than 5 minutes duration at least once per month. 3. Therapeutic anticoagulation for at least three weeks prior to initiation of therapy 4. Ability to complete 6 minute walk test. 5. Age \>= 18 years old. (Females must be either post-menopausal \>12 months, practicing a protocol-acceptable method of birth control \[defined as injectable or implantable hormonal contraceptives, oral contraceptives, intrauterine device, diaphragm plus spermicide\], or have had a hysterectomy, bilateral oophorectomy, or tubal ligation performed at least 6 months prior to enrollment). 6. All patients optimized on CHF medications including beta-blocker and ace-inhibitor or angiotensin-receptor blocker. 7. patients receiving low dose amiodarone- \<200 mg for 2 or less months Exclusion Criteria: The exclusion criteria are: 1. Reversible causes of AF such as pericarditis, hyperthyroidism, 2. Presently with Valvular Heart disease requiring surgical intervention 3. Presently with coronary artery disease requiring surgical intervention 4. Early Post-operative AF (within three months of surgery) 5. Previous MAZE or left atrial instrumentation 6. Prolonged QT interval 7. Hypothyroidism 8. Liver Failure 9. Life expectancy \<= 2 years 10. Social factors that would preclude follow up or make compliance difficult. 11. Contraindication to the use of anti-arrhythmic medications and/or coumadin and heparin 12. Enrollment in another investigational drug or device study. 13. Patients with severe pulmonary disease i.e. COPD or asthma 14. Documented intra-atrial thrombus, tumor, or another abnormality which precludes catheter introduction 15. Any ophthalmologic disorders (other than requiring glasses for vision correction)