Comparing GLP-1 agonists versus other weight loss interventions on risk of atrial fibrillation recurrence after catheter ablation: a meta-analysis

Obesity often co-exists with Atrial Fibrillation (AF) and poses challenges to ablation success. Whether glucagon-like peptide-1 (GLP-1) agonists have a role and how they compare to other weight loss interventions in preventing AF recurrence after catheter ablation remains unclear. We performed meta-analysis and included prior interventional and observational studies that investigated weight loss-related interventions on AF recurrence post-ablation. Included were weight loss interventions that entailed perioperative use of GLP-1 agonists (4 studies), non-pharmacological interventions such as lifestyle/ risk factors modifications (8 studies), and bariatric surgery (1 study). Primary outcome was recurrence of clinical AF or a requirement for further rhythm control post-ablation. Two randomized-control trials and 11 cohorts were included (n = 5,415). Overall, weight loss interventions were associated with significant reduction in AF recurrence post-ablation (RR = 0.63 [95% CI: 0.46—0.87]). Bariatric surgery was associated with reduced risk of AF recurrence (RR = 0.31 [0.13 to 0.75]), while GLP-1 agonists and lifestyle /risk factors modifications showed trends towards protection with borderline statistical significance (RR = 0.64 [95% CI 0.36 to 1.14]). However, only 1 study investigated bariatric surgery which should be interpreted with caution. Importantly, meta-regression showed that for each 1% absolute decrease in body weight achieved, there was 6.3% relative-risk reduction in AF recurrence (RR = 0.94 [0.90—0.98]), regardless of weight loss intervention subtype. Sustained continuation of weight loss post-ablation was a determining factor of lower recurrence (P = 0.03). Peri-operative weight loss interventions in obesity patients significantly reduced AF recurrence post-ablation, in a dose–response manner and irrespective of choice of intervention strategy. Sustained continuation of weight loss post-ablation is a key determinant of success. Forest plot for recurrence of AF stratified by interventions. Overall pooled risk ratio (RR) across all weight-loss interventions was 0.64 (95% CI: 0.47–0.87, heterogeneity: I² = 86 & τ2 = 0.23). In this meta-analysis studying 5,415 patients that include 2 randomized controlled trials, peri-operative weight loss interventions significantly reduced AF recurrence after catheter ablation, irrespective of the choice of intervention strategy. Meta-regression shows that for each 1% absolute decrease in body weight achieved, there was 6.3% relative risk reduction in AF recurrence. Sustained continuation of weight loss beyond ablation was a determining factor of lower AF recurrence. Weight loss in obesity patients significantly reduced AF recurrence after an ablation procedure, in a dose–response manner and irrespective of the choice of intervention strategy. Sustained weight control is a key determinant of success.