High liver fibrosis scores in MAFLD patients are associated with adverse atrial remodeling and related clinical outcomes

Atrial fibrillation (AF) is the most common arrhythmia in the world, linked to a remodeled left atrium. A number of epidemiological studies have suggested an association between metabolic dysfunction-associated fatty liver disease (MAFLD) and the incidence of AF. However, the pathogenesis leading to AF in the context of MAFLD remains unclear. We aimed at assessing the impact of MAFLD and liver fibrosis status on left atrium (LA) structure and function. Using two distinct cohorts, the patient's liver status is determined using validated blood biomarkers and clinical-biological scores (FLI, NFS). In the first cohort of patients undergoing AF ablation, the LA structural and functional impact of MAFLD was assessed by LA strain analysis and endocardial voltage mapping. Histopathological assessment of atrial fibrosis was performed in the second cohort of patients undergoing cardiac surgery. Finally, the impact of MAFLD on AF recurrence following catheter ablation was assessed. In the AF ablation cohort (n = 245), MAFLD patients with high risk of F3–F4 liver fibrosis presented more LA low-voltage areas compared to patients without MAFLD, impaired LA reservoir function assessed by peak left atrial longitudinal strain, and increased LA volume. Accordingly, among the MAFLD patients, those with a high risk of F3–F4 liver fibrosis presented a higher rate of AF recurrence during follow-up. These patients had permanent recurrent AF, therefore difficult to treat. In the cardiac surgery cohort (n = 20), an increase in histopathological atrial fibrosis was observed in MAFLD patients with a high risk of F3–F4 liver fibrosis. We found that liver fibrosis scoring in MAFLD patients is associated with adverse atrial remodeling and AF recurrences following catheter ablation. The impact of the management of MAFLD on LA remodeling and AF ablation outcomes should be assessed in dedicated studies. This work has been published in Frontier In Endocrinology in August 2022 (doi: 10.3389/fendo.2022.957245).