Key result
Metformin increased freedom from recurrent atrial arrhythmia at 12 months compared to usual care (78% vs 58%; HR 0.5; 95% CI 0.2-0.9; P=0.04) in patients with AF and elevated BMI without diabetes.
Why the study?
Obesity is a prevalent risk factor for recurrent AF after catheter ablation, and experimental and observational studies suggest metformin may reduce AF risk.
Does metformin reduce recurrent atrial arrhythmias in patients with AF, elevated BMI, and without diabetes undergoing catheter ablation?
RCT (n=99)
1:1
Does metformin reduce recurrent atrial arrhythmias in patients with AF, elevated BMI, and without diabetes undergoing catheter ablation?
In patients with AF and elevated BMI without diabetes, adjunctive metformin therapy significantly improves freedom from recurrent atrial arrhythmias following catheter ablation.
Answers are grounded in this paper and cite their sources.
Metformin may warrant consideration as adjunctive therapy post-AF ablation in obese non-diabetics; extends metabolic modulation to arrhythmia prevention trials.
BACKGROUND: Obesity is a prevalent risk factor for recurrent atrial fibrillation (AF) after catheter ablation. Experimental and observational studies suggest that metformin may reduce the risk of AF. OBJECTIVE: To determine the effect of metformin on recurrent atrial arrhythmias after catheter ablation for AF. METHODS: and without diabetes were randomized (1:1) to metformin or usual care before ablation. Metformin was titrated to the maximum tolerated dose and continued for 1 year after ablation. All patients received handheld electrocardiogram monitors in addition to usual clinical monitoring. The primary endpoint was freedom from recurrent atrial arrhythmia assessed at 12 months after ablation with a 3-month blanking period. At 12 months, the primary endpoint occurred in 38 (78%) of the metformin group and 29 (58%) of the usual care group (HR: 0.5; 95% CI: 0.2-0.9; P = 0.04). In the year after ablation, AF burden was lower in the metformin group (IQR: 0%-0%; median 0%) compared with usual care (IQR: 0%-25%; median 0%) (P = 0.03). Antiarrhythmic drugs were used in 4 of 49 patients (8%) in the metformin group and in 9 of 50 patients (18%) in the control group after ablation. CONCLUSIONS: In patients with AF, elevated BMI, and without diabetes, treatment with metformin may reduce recurrent atrial arrhythmias after ablation. These findings require confirmation in larger trials.
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Deshmukh et al. (2026) conducted an RCT in Atrial Fibrillation (n=99). Metformin vs. Usual care was evaluated on Freedom from recurrent atrial arrhythmia assessed at 12 months after ablation with a 3-month blanking period (HR 0.5, 95% CI 0.2-0.9, p=0.04). Metformin increased freedom from recurrent atrial arrhythmia at 12 months compared to usual care (78% vs 58%; HR 0.5; 95% CI 0.2-0.9; P=0.04) in patients with AF and elevated BMI without diabetes.
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