{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T15:58:34Z","timestamp":1790697514656,"version":"4.1.0"},"reference-count":30,"publisher":"IMR Press","issue":"9","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Cardiovasc. Med."],"abstract":"<jats:p>Background: Catheter ablation (CA) is an established rhythm-control strategy for atrial fibrillation (AF); however, AF recurrence remains common and is influenced by the underlying cardiometabolic substrate, including metabolic dysfunction-associated steatotic liver disease (MASLD). This study aimed to evaluate the association of MASLD and MASLD-related fibrosis risk with AF recurrence following CA. Methods: We conducted a systematic review and random-effects meta-analysis of observational studies reporting AF recurrence after CA, stratified by MASLD status and liver fibrosis risk, as assessed using the fibrosis-4 (FIB-4) index and the non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS). Eligible studies included adults undergoing CA for AF with recurrence outcomes reported and stratified by MASLD or fibrosis risk categories. Results: A total of 160 records were identified, and seven studies were included in the qualitative synthesis. Six studies, including 2921 patients, contributed to the primary meta-analysis comparing MASLD versus no MASLD. An additional fibrosis-only study contributed to fibrosis-stratified analyses. The meta-analysis of six studies (MASLD: 894; non-MASLD: 2027) demonstrated that MASLD was associated with a significantly higher risk of AF recurrence after CA (risk ratio (RR) 1.77, 95% confidence interval (CI) 1.43\u20132.18; p &lt; 0.001; I2 = 64.1%). In a separate meta-analysis of five studies reporting adjusted estimates, MASLD remained significantly associated with recurrence (hazard ratio (HR) 2.13, 95% CI 1.49\u20133.04; p &lt; 0.001; I2 = 70.5%). In fibrosis-stratified analyses, Intermediate\/High FIB-4 (RR 2.03, 95% CI 1.27\u20133.26; p = 0.003; I2 = 71.3%) and Intermediate\/High NFS (RR 1.65, 95% CI 1.12\u20132.43; p = 0.01; I2 = 49.9%) were associated with a higher risk of AF recurrence compared with low scores. Conclusion: MASLD is associated with a significantly higher risk of AF recurrence after CA. Fibrosis risk stratification using FIB-4 and NFS also shows a significant association between Intermediate\/High fibrosis and increased recurrence rates. PROSPERO Registration: CRD420261335405, https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420261335405.<\/jats:p>","DOI":"10.31083\/rcm54276","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T14:57:11Z","timestamp":1790693831000},"source":"Crossref","is-referenced-by-count":0,"title":["Metabolic Dysfunction-Associated Steatotic Liver Disease and Atrial Fibrillation Recurrence After Catheter Ablation: A Systematic Review and Meta-Analysis"],"prefix":"10.31083","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9260-6306","authenticated-orcid":true,"given":"Panagiotis","family":"Theofilis","sequence":"first","affiliation":[{"name":"Department of Cardiology, \u201cHippokration\u201d General Hospital of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3561-5713","authenticated-orcid":true,"given":"Paschalis","family":"Karakasis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ippokrateio General Hospital of Thessaloniki, 54642 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0736-4942","authenticated-orcid":true,"given":"Panayotis K.","family":"Vlachakis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cHippokration\u201d General Hospital of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5411-6461","authenticated-orcid":true,"given":"Konstantinos","family":"Pamporis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cHippokration\u201d General Hospital of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4532-0206","authenticated-orcid":true,"given":"Aikaterini","family":"Vordoni","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cHippokration\u201d General Hospital of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8079-0599","authenticated-orcid":true,"given":"Evangelos","family":"Oikonomou","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sotiria General Hospital, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3186-8905","authenticated-orcid":true,"given":"Kyriakos","family":"Dimitriadis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cHippokration\u201d General Hospital of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7601-8870","authenticated-orcid":true,"given":"Gerasimos","family":"Siasos","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sotiria General Hospital, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7636-6725","authenticated-orcid":true,"given":"Konstantinos","family":"Tsioufis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cHippokration\u201d General Hospital of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7492-4984","authenticated-orcid":true,"given":"Dimitris","family":"Tousoulis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cHippokration\u201d General Hospital of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"16242","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Steinberg BA, Li Z, O'Brien EC, Pritchard J, Chew DS, Bunch TJ, et al. 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