Abstract
BACKGROUND: Epidemiological evidence suggests an association between non-alcoholic fatty liver disease (NAFLD) and incident atrial fibrillation (AF); however, the magnitude of this association and its prognostic value in predicting the recurrence of AF after radiofrequency catheter ablation (RFCA) have not been fully characterized. The present study was designed to elucidate the complex interplay between NAFLD and the risk of AF recurrence after ablation. METHODS: A total of 1,182 patients with AF who underwent initial RFCA from June 2018 to December 2022 at the First Affiliated Hospital of Zhengzhou University were included in this retrospective cohort study. The Kaplan-Meier method was used to plot AF recurrence curves after ablation. Multivariable Cox models were then used to examine the associations between NAFLD and the recurrence of AF. Analyses were also conducted to assess whether the predictive effect of NAFLD was consistent across different subgroups. RESULTS: Over a 1-year follow-up period, 30.1% of the patients experienced recurrent AF. The multivariable Cox analysis revealed that NAFLD was an independent risk factor for the recurrence of AF after controlling for model 2 (hazard ratio =1.37, 95% confidence interval: 1.10-1.70, P=0.005). These correlations remained statistically significant across various models. Further, incorporating NAFLD in the fully adjusted basic risk model significantly increased the ability of the model to predict AF recurrence, with the C-statistic increasing from 0.672 to 0.686 (P=0.03). Additionally, diabetes mellitus (DM) (P value for interaction =0.049) and female sex (P value for interaction =0.02) had a statistically significant interactive effect with NAFLD in predicting the recurrence of AF. CONCLUSIONS: NAFLD was found to be independently associated with the recurrence of AF after ablation. Moreover, the AF recurrence rate after RFCA was higher in the NAFLD patients who had DM or were female. The study showed that NAFLD may serve as a dependable marker for assessing AF recurrence risk in clinical practice.