NAFLD may elevate risk for arrhythmia recurrence after AF ablation
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Nonalcoholic fatty liver disease was independently linked to recurrent atrial fibrillation after AF ablation, according to findings published in JACC: Clinical Electrophysiology.
In addition, patients with nonalcoholic fatty liver disease (NAFLD) had higher epicardial fat volume compared with patients without the disease.
For the retrospective study, investigators assessed 267 patients who underwent AF ablation, of whom 89 were diagnosed with NAFLD before the procedure. Patients were monitored for arrhythmia recurrence for an average of 29 months.
“An intertwined relationship exists between NAFLD and AF,” Eoin Donnellan, MD, electrophysiology fellow in the department of cardiovascular medicine at Cleveland Clinic, and colleagues wrote. “These two entities share several common risk factors, including obesity, diabetes, hypertension, sleep apnea and inflammation. Identifying the presence of NAFLD and determining stage has important implications for AF ablation outcomes.
“Moreover, NAFLD has been shown to be reversible through combination approaches, including weight loss and glycemic control,” the researchers wrote. “Therefore, NAFLD may offer a further modifiable target for risk factor optimization prior to AF ablation.”
Radiofrequency AF ablation was performed in 98% of patients while the remainder underwent cryoablation. Mean epicardial fat volume for the entire cohort was 232 mL.
Investigators observed recurrent arrhythmia after AF ablation in 56% of patients with NAFLD compared with 21% of those without (P < .0001).
After adjusting for BMI, HbA1c, left atrial size, statin use, aspartate transaminase, congestive HF, obstructive sleep apnea and AF type, the presence of NAFLD was found to be an independent predictor of arrhythmia recurrence (HR = 3.01; 95% CI, 1.94-4.68), according to the study.
Although epicardial fat volume was higher among patients with NAFLD (248 mL vs. 223 mL; P = .01), researchers observed no significant difference in fat volume among patients who developed recurrent arrhythmia and those who did not.
Epicardial fat volume was not associated with risk for arrhythmia recurrence (HR = 1.001; 95% CI, 0.99-1.003).
“This study is the first to specifically assess the impact of NAFLD on arrhythmia recurrence following AF ablation,” the researchers wrote. “Patients with NAFLD represent a particularly high-risk population for arrhythmia recurrence. NAFLD is a reversible disease, and a multidisciplinary approach incorporating dietary and lifestyle interventions should by instituted prior to ablation.”
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