Metabolic Dysfunction-Associated Steatotic Liver Disease and Atrial Fibrillation Recurrence After Catheter Ablation: A Systematic Review and Meta-Analysis.

Authors

Panagiotis Theofilis, Paschalis Karakasis, Panayotis K Vlachakis, Konstantinos Pamporis, Aikaterini Vordoni, Evangelos Oikonomou, Kyriakos Dimitriadis, Gerasimos Siasos, Konstantinos Tsioufis, Dimitris Tousoulis

Published in

Reviews in cardiovascular medicine. Volume 27. Issue 9. Pages 54276. Epub Sep 18, 2026.

Abstract

Catheter ablation (CA) is an established rhythm-control strategy for atrial fibrillation (AF); however, AF recurrence remains common and is influenced by the underlying cardiometabolic substrate, including metabolic dysfunction-associated steatotic liver disease (MASLD). This study aimed to evaluate the association of MASLD and MASLD-related fibrosis risk with AF recurrence following CA.
We conducted a systematic review and random-effects meta-analysis of observational studies reporting AF recurrence after CA, stratified by MASLD status and liver fibrosis risk, as assessed using the fibrosis-4 (FIB-4) index and the non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS). Eligible studies included adults undergoing CA for AF with recurrence outcomes reported and stratified by MASLD or fibrosis risk categories.
A total of 160 records were identified, and seven studies were included in the qualitative synthesis. Six studies, including 2921 patients, contributed to the primary meta-analysis comparing MASLD versus no MASLD. An additional fibrosis-only study contributed to fibrosis-stratified analyses. The meta-analysis of six studies (MASLD: 894; non-MASLD: 2027) demonstrated that MASLD was associated with a significantly higher risk of AF recurrence after CA (risk ratio (RR) 1.77, 95% confidence interval (CI) 1.43-2.18; p < 0.001; I² = 64.1%). In a separate meta-analysis of five studies reporting adjusted estimates, MASLD remained significantly associated with recurrence (hazard ratio (HR) 2.13, 95% CI 1.49-3.04; p < 0.001; I² = 70.5%). In fibrosis-stratified analyses, Intermediate/High FIB-4 (RR 2.03, 95% CI 1.27-3.26; p = 0.003; I² = 71.3%) and Intermediate/High NFS (RR 1.65, 95% CI 1.12-2.43; p = 0.01; I² = 49.9%) were associated with a higher risk of AF recurrence compared with low scores.
MASLD is associated with a significantly higher risk of AF recurrence after CA. Fibrosis risk stratification using FIB-4 and NFS also shows a significant association between Intermediate/High fibrosis and increased recurrence rates.
CRD420261335405, https://www.crd.york.ac.uk/PROSPERO/view/CRD420261335405.

PMID:
42859539
Bibliographic data and abstract were imported from PubMed on 11 Oct 2026.

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