The clinical relevance of catheter ablation in asymptomatic persistent atrial fibrillation (PeAF) remains uncertain, as current indications primarily focus on symptom relief. Patients without symptoms may have unrecognized impairments in exercise capacity or quality of life (QoL).

This single-center prospective observational study, published in Heart Rhythm, evaluated the association between catheter ablation and changes in exercise capacity and QoL in asymptomatic PeAF. Consecutive clinically asymptomatic patients undergoing catheter ablation between August 2021 and July 2024 were included. Asymptomatic status was defined as modified European Heart Rhythm Association (EHRA) class I without subjective symptoms.

Cardiopulmonary exercise testing (CPX), including anaerobic threshold (AT), peak oxygen uptake (peak VO₂), metabolic equivalents (METs), and O₂ pulse, along with QoL assessments using Atrial Fibrillation Quality of Life Questionnaire (AFQLQ) and EuroQol 5-Dimension 5-Level Questionnaire (EQ-5D-5L), were performed at baseline and at 3 and 12 months. A symptomatic PeAF cohort undergoing the same protocol was included for descriptive comparison.\

Among 68 asymptomatic patients, 52 completed 12-month follow-up. Significant increases were observed across all CPX parameters (AT: 12.8 to 14.0 mL/kg/min; peak VO₂: 18.0 to 19.4 mL/kg/min; METs: 5.3 to 5.8; O₂ pulse: 9.4 to 12.4 mL/beat; all P<0.05). AFQLQ scores improved early and remained stable, while EQ-5D-5L scores increased significantly at 12 months.

Compared with symptomatic patients, exercise capacity remained higher in asymptomatic patients at baseline and 12 months, while QoL scores became comparable after ablation.

These findings suggest that catheter ablation may provide functional and QoL benefits in asymptomatic PeAF despite absence of reported symptoms.