Association of glucagon-like peptide-1 receptor agonist therapy with atrial fibrillation recurrence after catheter ablation: a systematic review and meta-analysis

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide, with a rising global prevalence. Post-ablation AF recurrence remains frequent, particularly among patients with obesity and metabolic syndrome. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have demonstrated favorable cardiometabolic and cardiovascular effects, but their association with AF recurrence after ablation remains uncertain. PubMed, Scopus, Embase, and Web of Science were searched through June 18, 2026. Cohort studies evaluating GLP-1RA therapy in adults with atrial fibrillation undergoing catheter ablation were included. The primary outcome was post-ablation atrial fibrillation recurrence (or recurrent atrial tachyarrhythmia, as defined by the individual studies). Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Risk of bias was assessed using the JBI tool, and certainty of evidence was evaluated using the GRADE approach. Six cohort studies (three prospective and three retrospective), comprising 14,278 patients (7,065 GLP-1RA users and 7,213 controls), met the inclusion criteria. Follow-up duration ranged from 12 to 24 months across studies. The pooled mean age was approximately 64 years in both the GLP-1RA and control groups. GLP-1RA therapy was associated with a lower hazard of AF recurrence compared with the respective comparator groups (HR = 0.74, 95% CI 0.63–0.87; I² = 50.5%). However, the certainty of the evidence was low because the findings were derived predominantly from observational studies. Observational evidence suggests that GLP-1RA use is associated with a lower hazard of AF recurrence following catheter ablation. However, these findings should be interpreted cautiously, and further high-quality randomized controlled trials are required to confirm this association.