Fujisawa T; Department of Cardiology Ehime University Graduate
School of Medicine, Ehime, Japan
Kawakami H; Kurokawa K; Horie R; Tamaki S; et al

Heart Rhythm. 23(7):e1000-e1011, 2026 Jul.

BACKGROUND: The clinical importance of catheter ablation (CA) in
asymptomatic persistent atrial fibrillation (PeAF) remains uncertain,
given that 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: This study aimed to prospectively evaluate changes in exercise
capacity and QoL after CA in patients with asymptomatic PeAF.

METHODS: This single-center prospective observational study enrolled
consecutive patients with clinically asymptomatic PeAF who underwent CA
between August 2021 and July 2024. Asymptomatic status was defined as
modified European Heart Rhythm Association class I without subjective
symptoms. Cardiopulmonary exercise testing-including anaerobic threshold,
peak oxygen (O2) uptake, metabolic equivalents, and O2 pulse-and QoL
assessments (Atrial Fibrillation Quality of Life Questionnaire and EuroQol
5-Dimension 5-Level) were performed at baseline and 3 and 12 months after
ablation. A symptomatic PeAF cohort assessed under the same protocol was
included for a secondary descriptive comparison.

RESULTS: Among the 68 patients with asymptomatic PeAF, 52 completed the
12-month evaluation. All cardiopulmonary exercise testing parameters
improved significantly after ablation (anaerobic threshold 12.8 -> 14.0
mL/kg/min; peak O2 uptake 18.0 -> 19.4 mL/kg/min; metabolic equivalents
5.3 -> 5.8; O2 pulse 9.4 -> 12.4 mL/beat; all P < .05). The Atrial
Fibrillation Quality of Life Questionnaire scores improved early and
remained stable, whereas the EuroQol 5-Dimension 5-Level 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 after ablation.

CONCLUSION: CA 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.