Impact of Metabolic Dysfunction-Associated Fatty Liver Disease on Atrial Fibrillation Recurrence After Ablation　― A Retrospective Study in Japanese Patients ―

Abstract

Background: Metabolic derangements are associated with incident and recurrent atrial fibrillation (AF), in addition to the development of metabolic dysfunction-associated fatty liver disease (MAFLD). A recent study reported MAFLD was associated with significantly increased arrhythmia recurrence rates following AF ablation in Western patients. However, in Asian patients with a higher prevalence of non-obese MAFLD, it is not clear whether MAFLD affects recurrence after AF ablation regardless of obesity. This study investigated the impact of MAFLD on AF recurrence in Japanese patients.

Methods and Results: We enrolled 872 patients who underwent AF ablation and assessed the relationship between MAFLD and AF recurrence. The prevalence of MAFLD was significantly higher in the group with than without AF recurrence. Although the liver/spleen ratio was significantly lower among patients with than without AF recurrence, the liver fibrosis score did not differ significantly between the 2 groups. Multivariate Cox proportional hazards regression analysis identified MAFLD, but not body mass index, as a factor independently associated with AF recurrence (adjusted hazard ratio 2.62; 95% confidence interval 1.44–4.80; P=0.002). We found a significant interaction between MAFLD and homeostasis model assessment of insulin resistance (HOMA-IR; P for interaction=0.034).

Conclusions: MAFLD is an independent risk factor for recurrence after AF ablation in Japanese patients regardless of obesity, and its effects are likely heterogeneous, with a greater impact in the presence of insulin resistance.