Exercise capacity and quality-of-life improvements after catheter ablation in patients with clinically asymptomatic persistent atrial fibrillation

Background The clinical importance of catheter ablation in asymptomatic persistent atrial fibrillation (PeAF) remains uncertain, as current indications mainly focus on symptom relief. Asymptomatic patients may have unrecognized impairments in exercise capacity or quality of life (QoL), but prospective data are limited. Objective To prospectively evaluate the changes in exercise capacity and QoL post-catheter ablation in asymptomatic PeAF patients. Methods This single-center prospective observational study enrolled consecutive clinically asymptomatic PeAF patients who underwent catheter ablation between August 2021 and July 2024. Asymptomatic status was defined as modified EHRA class I without subjective symptoms. Cardiopulmonary exercise testing (CPX)—including anaerobic threshold (AT), peak oxygen uptake (peak VO 2 ), metabolic equivalents (METs), and O 2 pulse—and QoL assessments (AFQLQ and EQ-5D-5L) were performed at baseline and 3 and 12 months post-ablation. A symptomatic PeAF cohort assessed under the same protocol was included for a secondary descriptive comparison. Results Among the 68 asymptomatic PeAF patients, 52 completed the 12-month evaluation. All CPX parameters improved significantly post-ablation (AT: 12.8→14.0 mL/kg/min; peak VO 2 : 18.0→19.4 mL/kg/min; METs: 5.3→5.8; O 2 pulse: 9.4→12.4 mL/beat; all p < 0.05). The AFQLQ scores improved early and remained stable, whereas the EQ-5D-5L score significantly improved only at 12 months. Secondary comparison with symptomatic patients showed higher exercise capacity in asymptomatic patients at baseline and 12 months, whereas the QoL scores became comparable post-ablation. Conclusion Catheter ablation in asymptomatic PeAF was associated with sustained improvements in exercise capacity and QoL, suggesting that rhythm-control therapy may provide functional benefit even without overt symptoms.