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 (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.