Background: Although catheter ablation (CA) is an effective treatment for patients with AF and LVSD, the efficacy of an initial cryo-ablation strategy is unknown. This study evaluated long term outcomes of patients with an initial cryo-ablation strategy for AF and LV systolic dysfunction (LVSD). Methods: Outcomes of patients undergoing index cryoablation for AF from January 2008 until March 2018, with documented pre-ablation LVEF45% were evaluated for long term freedom from AF and change in ventricular function from baseline. Results: 76 patients met inclusion criteria. Patients were predominantly male (80%), aged 63 11yrs, with an average CHADS2 VASc score of 2.66  1.40, baseline LVEF 34  8.7% (ischaemic in 37%) and NYHA class 2.37  0.72. Repeat procedures were performed in 13%. The single procedure success was 70% at 1 year (81% for paroxysmal AF, 65% for persistent AF, 29% for long-standing persistent AF) and at 28  13 months follow up was 43% (50%, 41% and 21% respectively), increasing to 59% allowing for subsequent redo procedure with RF ablation (64%, 57%, and 50% respectively). At follow up, LVEF significantly improved to 46  16% (p<0.001), and NYHA reduced to 1.51  0.66 (p<0.001). Conclusion: An initial strategy of cryoablation in patients with AF and LVSD is an effective approach in the treatment of patients with concurrent AF and LVSD. Larger, randomised prospective studies are required to confirm these findings.