Abstract 4355053: Changes in Cardiopulmonary Exercise Performance Following Atrial Fibrillation Ablation

Background: Recent studies have shown that catheter ablation (CA) for atrial fibrillation (AF) was associated with significant hemodynamic improvements, improved exercise capacity, increased six-minute walk distance, and better quality of life. However, its impact on cardiopulmonary exercise testing (CPET) has shown inconsistent results across patients with cardiovascular disease. Methods: We conducted a systematic review and meta-analysis of MEDLINE and EMBASE through March 2025 to evaluate changes in CPET among patients who underwent AF ablation, including studies that reported CPET data before and after the procedure within one year. Key outcomes included changes in peak VO 2 (ml/kg/min), VE/VCO 2 slope, and anaerobic threshold (AT; ml/kg/min). We extracted mean and standard deviation values from each study and calculated pooled mean differences (MD) using the generic inverse variance method. Results: A total of 9 studies were included in the analysis. Among patients who underwent AF ablation, there were significant improvements in peak VO 2 , VE/VCO 2 slope, and AT compared to pre-procedure values. The pooled MD for peak VO 2 was +1.80 ml/kg/min (95% CI: 1.15 to 2.45; p < 0.001; I 2 = 8%), for VE/VCO 2 slope was −1.02 (95% CI: −1.78 to −0.26; p = 0.008; I 2 = 16%), and for AT was +1.46 ml/kg/min (95% CI: 0.51 to 2.41; p = 0.003; I 2 = 68%). Conclusion: Our study found that patients who underwent AF-CA experienced significant improvements in exercise capacity within one year of follow-up, as reflected by improvements in peak VO 2 , VE/VCO 2 slope, and anaerobic threshold. Further research is needed to elucidate the underlying mechanisms driving these improvements.