Author + information
- Received February 14, 2020
- Revision received May 15, 2020
- Accepted May 18, 2020
- Published online August 12, 2020.
- Eoin Donnellan, MDa,
- Thomas G. Cotter, MDb,
- Oussama M. Wazni, MDa,
- Mohamed B. Elshazly, MDa,
- Arshneel Kochar, MDa,
- Bryan Wilner, MDa,
- Divyang Patel, MDa,
- Mohamed Kanj, MDa,
- Ayman Hussein, MDa,
- Bryan Baranowski, MDa,
- Daniel Cantillon, MDa,
- Brian Griffin, MDa,
- Wael Jaber, MDa and
- Walid I. Saliba, MDa,∗ ()
- aDepartment of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
- bDepartment of Gastroenterology and Hepatology, University of Chicago, Chicago, Illinois
- ↵∗Address for correspondence:
Dr. Walid I. Saliba, Department of Cardiovascular Electrophysiology, Cleveland Clinic, 9500 Euclid Avenue. J1-5, Cleveland, Ohio 44195.
Objectives This study sought to investigate the association between nonalcoholic fatty liver disease (NAFLD) and arrhythmia recurrence following atrial fibrillation ablation; and to examine the impact of NAFLD stage on outcomes.
Background Metabolic derangements, including obesity and diabetes, are associated with incident and recurrent atrial fibrillation (AF), in addition to the development of NAFLD.
Methods This was a retrospective study of 267 consecutive patients undergoing AF ablation, 89 of whom 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.
Results 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 (248 ± 125 ml vs. 223 ± 97 ml; p = 0.01). On multivariable 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 (hazard ratio: 3.010; 95% confidence interval: 1.980 to 4.680; p < 0.0001).
Conclusions NAFLD is associated with significantly increased arrhythmia recurrence rates following AF ablation. Identification and reversal, where possible, may result in improved arrhythmia-free survival.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received February 14, 2020.
- Revision received May 15, 2020.
- Accepted May 18, 2020.
- 2020 American College of Cardiology Foundation
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