ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiac Rhythmology
Impact of Nonalcoholic Fatty Liver Disease on Atrial Fibrillation Recurrence After Catheter Ablation: A Prospective Cohort Study
Zhe Xu 1,2,3,4,5
Tao Yi 1,2,3,4,5
Xuehai Chen 1,2,3,4,5
Kezeng Gong 1,2,4,3,5
Feilong Zhang 1,2,4,3,5
Yunling Lin 1,2,4,3,5
1. Fujian Medical University Union Hospital, Fuzhou, China
2. Fujian Cardiovascular Medical Center, Fuzhou, China
3. Fujian Institute of Coronary Heart Disease, Fuzhou, China
4. Fujian Cardiovascular Research Center, Fuzhou, China
5. Fujian Medical University Heart Center, Fuzhou, China
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Abstract
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.
Summary
Keywords
AF, Atrial Fibrillation, Catheter Ablation, Fibrosis, NAFLD, nonalcoholic fatty liver disease
Received
15 November 2025
Accepted
19 February 2026
Copyright
© 2026 Xu, Yi, Chen, Gong, Zhang and Lin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Yunling Lin
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