Should We Perform Catheter Ablation for Asymptomatic Atrial Fibrillation?

Since the original description of atrial fbrillation ablation, numerous studies have demonstrated the superiority of catheter ablation over pharmacological therapy for maintenance of sinus rhythm in patients with both paroxysmal and persistent atrial fbrillation. However, to date, no randomized studies have been powered to demonstrate a mortality or stroke reduction benefit of rhythm control with catheter ablation over a rate control strategy. The results of such ongoing studies are not expected until 2018 or 2019. Thus, the only indication for atrial fbrillation ablation in recent guidelines has been the presence of symptoms. However, up to 40% of an atrial fbrillation population may be asymptomatic. In 2017, in the absence of randomized studies, are there nevertheless data that support atrial fbrillation ablation in asymptomatic patients?