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Publications

Journal Article Systematic Review Epublish

PubMed: 42859539 DOI: 10.31083/RCM54276

Metabolic Dysfunction-Associated Steatotic Liver Disease and Atrial Fibrillation Recurrence After Catheter Ablation: A Systematic Review and Meta-Analysis.

Rev Cardiovasc Med 27(9):54276

Authors: Panagiotis Theofilis, Paschalis Karakasis, Panayotis K Vlachakis, Konstantinos Pamporis, Aikaterini Vordoni, Evangelos Oikonomou, Kyriakos Dimitriadis, Gerasimos Siasos, Konstantinos Tsioufis, Dimitris Tousoulis

Affiliations

  • Department of Cardiology, "Hippokration" General Hospital of Athens, 11527 Athens, Greece.
  • Department of Cardiology, Ippokrateio General Hospital of Thessaloniki, 54642 Thessaloniki, Greece.
  • Department of Cardiology, Sotiria General Hospital, 11527 Athens, Greece.

Abstract

BACKGROUND

Catheter ablation (CA) is an established rhythm-control strategy for atrial fibrillation (AF); however, AF recurrence remains common and is influenced by the underlying cardiometabolic substrate, including metabolic dysfunction-associated steatotic liver disease (MASLD). This study aimed to evaluate the association of MASLD and MASLD-related fibrosis risk with AF recurrence following CA.

METHODS

We conducted a systematic review and random-effects meta-analysis of observational studies reporting AF recurrence after CA, stratified by MASLD status and liver fibrosis risk, as assessed using the fibrosis-4 (FIB-4) index and the non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS). Eligible studies included adults undergoing CA for AF with recurrence outcomes reported and stratified by MASLD or fibrosis risk categories.

RESULTS

A total of 160 records were identified, and seven studies were included in the qualitative synthesis. Six studies, including 2921 patients, contributed to the primary meta-analysis comparing MASLD versus no MASLD. An additional fibrosis-only study contributed to fibrosis-stratified analyses. The meta-analysis of six studies (MASLD: 894; non-MASLD: 2027) demonstrated that MASLD was associated with a significantly higher risk of AF recurrence after CA (risk ratio (RR) 1.77, 95% confidence interval (CI) 1.43-2.18; p < 0.001; = 64.1%). In a separate meta-analysis of five studies reporting adjusted estimates, MASLD remained significantly associated with recurrence (hazard ratio (HR) 2.13, 95% CI 1.49-3.04; p < 0.001; = 70.5%). In fibrosis-stratified analyses, Intermediate/High FIB-4 (RR 2.03, 95% CI 1.27-3.26; p = 0.003; = 71.3%) and Intermediate/High NFS (RR 1.65, 95% CI 1.12-2.43; p = 0.01; = 49.9%) were associated with a higher risk of AF recurrence compared with low scores.

CONCLUSION

MASLD is associated with a significantly higher risk of AF recurrence after CA. Fibrosis risk stratification using FIB-4 and NFS also shows a significant association between Intermediate/High fibrosis and increased recurrence rates.

PROSPERO REGISTRATION

CRD420261335405, https://www.crd.york.ac.uk/PROSPERO/view/CRD420261335405.

MeSH

Liver Diseases, Fibrosis, Non-Alcoholic Fatty Liver Disease, Atrial Fibrillation, Liver, Catheter Ablation, Catheters