Association of MASLD With Atrial Fibrillation Recurrence After Catheter Ablation: A Meta-Analysis

Atrial fibrillation (AF) recurrence after catheter ablation remains common. Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized as a cardiometabolic condition and has been linked to incident AF, but its association with AF recurrence after catheter ablation remains unclear. This meta-analysis aimed to determine whether MASLD is associated with recurrent AF after catheter ablation METHODS: We searched PubMed, Web of Science, and Scopus till July 2026 for studies that included adults with AF undergoing catheter ablation and compared the risk of AF recurrence between those with and without MASLD. A random-effects model was used to synthesize HRs and corresponding 95% CIs. Between-study variability was evaluated with the I² measure, with additional subgroup analyses stratified by AF type and MASLD diagnostic method.

Six studies comprising 2921 patients (894 with MASLD) were included. MASLD was significantly associated with an increased risk of AF recurrence after ablation (HR 1.91, 95% CI 1.39-2.64; p < 0.001), with substantial heterogeneity (I² = 69.7%). The association remained significant in both paroxysmal (HR 1.78, 95% CI 1.36-2.33) and persistent AF (HR 1.61, 95% CI 1.26-2.05), with no significant subgroup difference (p = 0.58). Studies using imaging-based diagnosis of MASLD showed a significant association, whereas the association was not significant when the Fatty Liver Index was used, with no evidence of a difference between diagnostic-method subgroups (p = 0.47) CONCLUSION: MASLD is associated with a higher risk of AF recurrence after catheter ablation and may help identify patients at greater risk of recurrence. Further prospective studies are needed to provide a more comprehensive understanding of this association.