What happens to maximum heart rate after an ablation?
Does the heart work less effectively since its been burned?
What about things like HRV and VO2 max?
Peter Attia talks a lot about VO2 being best predictor of longevity.

My 2 cents.

"When atrial fibrillation develops, there is loss of the atrial transport factor ("atrial kick"), with consequent decrease of cardiac output. Stroke output declines by 20-30% in normal individuals with loss of atrial kick; the decline in stroke output is considerably larger in patients with heart disease." Source: [pubmed.ncbi.nlm.nih.gov].

Hence, if you are in persistent afib, your heart function would be much improved with NSR from an ablation.

I'm a paid subscriber to Attia & am well aware of the data he presents on VO2 max. Doug McGuff MD is an ER doc who has also owned a personal training studio since 1997. His facility trains people using a "Super Slow" protocol. A number of his training clients started as seniors who were very out of shape and after training, improved their functionality dramatically. I think this functionality is what Attia is striving for. You can read some of McGuff's stories about his training clients in his "Body by Science" book.

As a 68 year old who has had afib for over 19 years, I do all of the stuff that Attia recommends, lots of Zone 2, HIT on a fan bike, KAATSU BFR, strength training, but I generally use 90 second isometrics for this. If I thought my situation needed an ablation, I would get one.

Ablation leaves lesions that become fibrotic as they heal. Fibrotic tissue is inelastic and more resistant to changes in geometry. So, yes, technically, there is a reduction in output after ablation from the output of the pre-AF healthy heart. During AF, the heart's capacity in obviously compromised, as should be intuitively clear. However, I think the net is going to be considerably higher for a heart in NSR and whose valves, all four, are in good health.

Subsequent ablations should increase the amount or extent of fibrosis is one assumes that the subsequent ablations are necessarily going to have to zap healthy tissue over which SA node or AV-re-entrant signals are still getting through and causing ectopic beats.

VO2 Max is a function of the circulatory system working in concert with mitochondria in skeletal muscle to convert glucose or ketones into energy using the available/free oxygen. You have as much to gain by physical training to improve VO2 as you do in returning your heart to NSR.

Not just VO2, but lung capacity, bone density, the degree of heart disease as one ages, and not least, muscle mass and tone in the skeletal masses meant to keep you erect and functional...and out of a wheel chair. Don't forget a healthy vestibular system. Falls from vestibular disorders are more lethal as we get past 75 or so, with variance.

Thanks all.