Combined assessment of nonalcoholic fatty liver disease fibrosis score and B-type natriuretic peptide for predicting atrial fibrillation recurrence after catheter ablation: A multicenter study

Abstract Background Combined assessment of the left and right atrial overload has been associated with atrial fibrillation (AF) recurrence following catheter ablation. Objective To investigate whether liver fibrosis scores are associated with right atrial remodeling and to evaluate the prognostic value of combining these scores with B-type natriuretic peptide (BNP) levels. Methods This study included a retrospective single-center cohort (n=212) and a prospective multicenter validation cohort (n=250) of patients who underwent first-time ablation for AF. Liver fibrosis scores, including the non-alcoholic fatty liver disease fibrosis score (NFS), fibrosis-4 index (FIB-4), and aspartate aminotransferase-to-platelet ratio index (APRI), were calculated before the procedure. The right atrial volume was assessed using three-dimensional computed tomography. Results NFS was significantly associated with atrial arrhythmia recurrence after catheter ablation, whereas the FIB-4 index and APRI were not. Adding NFS to BNP further enhanced risk prediction. The patients were stratified into three groups based on the median NFS and BNP values to ensure balanced group sizes. Patients with elevated levels of both (Group C) exhibited the worst clinical profiles and the highest recurrence rates. Group C was independently associated with atrial arrhythmia recurrence (hazard ratio, 3.07; 95% confidence interval, 1.07–8.77; p < 0.05). These findings were validated in the multicenter cohort, where Group C similarly had the worst clinical characteristics and remained an independent predictor of recurrence (hazard ratio, 2.27; 95% confidence interval, 1.17–4.40; p < 0.05). Conclusion The combined assessment of NFS and BNP enables non-invasive risk stratification by capturing bi-atrial overload and may help identify high-risk patients.