Impact of GLP-1 Receptor Agonist Therapy on Atrial Fibrillation Recurrence After Catheter Ablation in Obese Patients: A Real-World Data Analysis

Background GLP-1 receptor agonists (GLP-1RAs), initially developed for glycemic control in type 2 diabetes, have shown cardiometabolic benefits including weight loss, improved endothelial function, and reduced inflammation. Recent data suggest potential anti-arrhythmic effects via modulation of atrial substrate and autonomic tone. Their impact in obese, non-diabetic patients remains underexplored. This study examines whether GLP-1RA use is associated with reduced AF recurrence after catheter ablation in obese patients, using real-world data from a large multicenter database. Methods We conducted a retrospective cohort study using the TriNetX research network, which contains de-identified electronic health records from more than 100 million patients. Adult patients (age ≥18 years) with obesity (BMI >30 kg/m 2 ) who underwent AF ablation between January 2005 and January 2025 were eligible. The cohort was divided into GLP-1RA users (n = 2,867) and non-users (n = 2,867), with 1:1 propensity score matching performed across 82 clinical and demographic variables including age, sex, race, AF subtype, cardiovascular comorbidities, and baseline medications. Results During a median follow-up of 1.6 years (IQR: 2.6): AF recurrence was significantly lower in GLP-1RA users (7.43% vs. 8.40%, HR 0.843, 95%CI 0.780-0.911, p<0.0001) Progression to permanent AF occurred less frequently in GLP-1RA users (3.15% vs. 4.35%, HR 0.743, 95%CI 0.610–0.905, p=0.003). Risk of all-cause mortality was lower in the GLP-1RA group (HR 0.700, 95%CI 0.553–0.887, p=0.003) HF hospitalization (HR 0.819, 95%CI 0.722-0.929, p=0.002) and cardiovascular hospitalizations (HR 0.856, 95%CI 0.773-0.947, p=0.003) were also significantly lower with GLP-1RA use. No significant difference was found for redo ablation. Conclusion In a large real-world cohort of obese patients undergoing catheter ablation for AF, GLP-1RA therapy was associated with lower risks of AF recurrence, progression to permanent AF, cardiovascular hospitalizations, and mortality.