Impact of nonalcoholic fatty liver disease on atrial fibrillation recurrence after catheter ablation: a prospective cohort study

Background Nonalcoholic fatty liver disease (NAFLD), prevalent in 25% globally, correlates with heightened cardiovascular risks. Retrospective studies suggest NAFLD increases post-ablation atrial arrhythmia recurrence, but prospective evidence is lacking. Methods This registered cohort study (ChiCTR2200059079) enrolled 106 AF ablation patients (53 NAFLD vs. 53 non-NAFLD). AF recurrence risk was assessed using multivariable Cox proportional hazards regression. NAFLD was diagnosed per American Association for the Study of Liver Diseases criteria, with fibrosis staged by FIB-4 (Fibrosis-4 index). Results NAFLD patients exhibited higher recurrence rates (49.1% vs. 24.5%, p = 0.022; annualized incidence: 48.1 vs. 24.0 per 100 person-years). Advanced fibrosis (FIB-4 > 1.30) amplified recurrence risk (71.4% vs. 34.4%, p = 0.024). Metabolic indices (BMI/glucose/lipids) did not independently predict outcomes. Conclusion NAFLD independently predicts AF recurrence post-ablation, with fibrosis severity stratifying risk. This underscores NAFLD management as a potential therapeutic target.