Impact of advanced liver fibrosis on atrial fibrillation recurrence after ablation in non-alcoholic fatty liver disease patients

Zhe Wang; Yijia Wang; Fangyuan Luo; Yafei Zhai; Jiaju Li; Yinong Chen; Qing Li; Longyang Zhu; Siqi Jiao; Peng Liu; Yifeng Zhou; Yingwei Chen; Jianzeng Dong; Yihong Sun

doi:10.3389/fcvm.2022.960259

Impact of advanced liver fibrosis on atrial fibrillation recurrence after ablation in non-alcoholic fatty liver disease patients

Front Cardiovasc Med. 2022 Oct 6:9:960259. doi: 10.3389/fcvm.2022.960259. eCollection 2022.

Authors

Zhe Wang¹, Yijia Wang², Fangyuan Luo³, Yafei Zhai³, Jiaju Li³, Yinong Chen⁴, Qing Li⁴, Longyang Zhu⁴, Siqi Jiao⁴, Peng Liu⁵, Yifeng Zhou⁵, Yingwei Chen³, Jianzeng Dong^{3

6}, Yihong Sun^{1

4

5}

Affiliations

¹ Department of Cardiology, China-Japan Friendship Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
² Department of Cardiology, Beijing Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
³ Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
⁴ Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China.
⁵ Department of Cardiology, China-Japan Friendship Hospital, Beijing, China.
⁶ Department of Cardiology, Anzhen Hospital Affiliated to Capital Medical University, Beijing, China.

Abstract

Aim: Advanced liver fibrosis is independently associated with new onset of atrial fibrillation (AF). Non-invasive liver fibrosis scores are considered an effective strategy for assessing liver fibrosis. This study aimed to investigate the association between advanced liver fibrosis and AF recurrence after ablation in patients with non-alcoholic fatty liver disease (NAFLD).

Materials and methods: A total of 345 AF patients with NAFLD who underwent de novo ablation between 2019 and 2020 at two large hospitals in China were included in this study. AF recurrence was defined as the occurrence of atrial arrhythmia for more than 30 s by electrocardiogram or 24 h Holter monitoring after the first 3 months of ablation. Predictive values of non-alcoholic fatty liver disease fibrosis score (NFS) and Fibrosis-4 (FIB-4) scores for AF burden and recurrence after ablation were assessed.

Results: At the 1 year follow-up after ablation, 38.8% of patients showed recurrence. Patients with recurrence who had higher FIB-4 and NFS scores were more likely to have persistent AF and a duration of AF ≥ 3 years. In Kaplan-Meier analysis, patients with intermediate and high NFS and FIB-4 risk categories had a higher risk of AF recurrence. Compared to patients with the low risk, intermediate and high NFS, and FIB-4 risk were independently associated with AF recurrence in multivariate Cox regression analysis (high risk: NFS, hazard ratio (HR): 3.11, 95% confidence interval (CI): 1.68∼5.76, p < 0.001; FIB-4, HR: 3.91, 95% CI: 2.19∼6.98, p < 0.001; intermediate risk: NFS, HR: 1.85, 95% CI: 1.10∼3.10, p = 0.020; FIB-4, HR: 2.08, 95% CI: 1.27∼3.41, p = 0.003).

Conclusion: NFS and FIB-4 scores for advanced liver fibrosis are associated with AF burden. Advanced liver fibrosis is independently associated with AF recurrence following ablation. Advanced liver fibrosis might be meaningful in risk classification for patients after AF ablation.

Keywords: atrial fibrillation; liver fibrosis; non-alcoholic fatty liver disease; radiofrequency ablation; recurrence.