NAFLD linked to Increased Arrhythmia recurrence after AF Ablation

A recent study from Cleveland Clinic found that following Ablation for Atrial Fibrillation there is significantly increased recurrence of Arrhythmia in Non Alcoholic Fatty Liver Disease (NAFLD). The study was published in Journal ' JACC: Clinical Electrophysiology, 2020.

The association is concerning given that one in four adults in the United States has NAFLD, and up to 6.1 million Americans are estimated to have AF.

NAFLD is a pathologic condition occurring with increased prevalence in patients with Type 2 Diabetes. The incidence and recurrence of atrial fibrillation (AF), are associated with metabolic derangements like obesity and diabetes. Apart from AF they can also lead to the development of NAFLD. Researchers from Cleveland clinic and University of Chicago conducted a study to investigate the association between NAFLD and arrhythmia recurrence following atrial fibrillation ablation. They also examined the impact of NAFLD stage on outcomes.

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The recent study was a retrospective study conducted on 267 consecutive patients undergoing AF ablation. Out of these 267 patients 89 were diagnosed with NAFLD prior to ablation and matched in a 2:1 manner based on age, sex, body mass index, ejection fraction, and AF type with 178 patients without NAFLD. Patients were monitored for arrhythmia recurrence during a mean follow-up of 29 months.

The key findings of the study were:

• Recurrent arrhythmia was observed in 50 (56%) patients with NAFLD compared with 37 (21%) without NAFLD.

• Epicardial fat volume was measured on computed tomography and was significantly higher among those with NAFLD (p = 0.01).

• On multi-variable models adjusting for sleep apnea, body mass index, heart failure, AF type, and left atrial size, NAFLD was independently associated with increased rates of arrhythmia recurrence (p < 0.0001).

Thus, the authors concluded that NAFLD is associated with significantly increased arrhythmia recurrence rates following AF ablation. They further added that Identification and reversal, where possible, may result in improved arrhythmia-free survival.

For further reading, click the following link:  https://doi.org/10.1016/j.jacep.2020.05.023