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September 18, 2026Heart Rhythm

GLP-1 RA and SGLT2i show similar post-ablation AF recurrence, but their combination is linked to lower mortality.

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Why the study?

Do GLP-1 receptor agonists, SGLT2 inhibitors, or their combination reduce AF recurrence in adults with atrial fibrillation undergoing catheter ablation?

Population

Adults with atrial fibrillation who underwent catheter ablation for AF, identified from the TriNetX database.

Comparison

Glucagon-like peptide-1 receptor agonists… vs Pairwise comparisons between the groups: GLP-1…

Design

Cohort

Key result

GLP-1 RA vs SGLT2i showed similar AF recurrence after catheter ablation (HR 1.01; 95% CI 0.89-1.15), but combination therapy was associated with lower all-cause mortality than either alone.

Authors

ARAdham RamadanMDMohamed DomaMYMohammad Hosein Yazdanpanah

Discussion

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Overview

Similar AF recurrence with GLP-1 RA or SGLT2i warrants no practice change; combination mortality association is hypothesis-generating.

Key Points

  • To assess the individual and combined effects of GLP-1 receptor agonists and SGLT2 inhibitors on atrial fibrillation recurrence and clinical outcomes following catheter ablation.
  • Analyzed adults with atrial fibrillation in the TriNetX database (2018–2024) who received GLP-1 receptor agonists, SGLT2 inhibitors, or both within 12 months before catheter ablation.
  • Conducted propensity score matching across three groups: GLP-1 RA vs SGLT2i (n=1,393 each), combination vs GLP-1 RA (n=952 each), and combination vs SGLT2i (n=1,213 each).
  • Evaluated primary atrial fibrillation recurrence (repeat ablation, cardioversion, or antiarrhythmic drug initiation after a 3-month blanking period) and secondary cardiovascular outcomes.
  • Atrial fibrillation recurrence did not differ significantly between GLP-1 RA and SGLT2i (HR 1.01, 95% CI 0.89–1.15; p=0.86), combination versus GLP-1 RA (HR 1.13, 95% CI 0.98–1.31; p=0.10), or combination versus SGLT2i (HR 1.09, 95% CI 0.96–1.24; p=0.20).
  • Combination therapy was associated with significantly reduced all-cause mortality compared to GLP-1 RA alone (HR 0.54, 95% CI 0.34–0.87; p=0.01) and SGLT2i alone (HR 0.60, 95% CI 0.39–0.93; p=0.02).
  • Secondary outcomes, including stroke, heart failure, and all-cause hospitalization, showed no significant differences among all comparison groups.

Study Design

Type

Cohort

Multicenter

Yes

Structured PICO

Do GLP-1 receptor agonists, SGLT2 inhibitors, or their combination reduce AF recurrence in adults with atrial fibrillation undergoing catheter ablation?

P
Population
Adults with atrial fibrillation who underwent catheter ablation and used GLP-1 RA, SGLT2i, or combination therapy within 12 months prior.
E
Exposure
Glucagon-like peptide-1 receptor agonists (GLP-1 RA), sodium-glucose cotransporter 2 inhibitors (SGLT2i), or their combination used within 12 months prior to catheter ablation.
C
Comparator
Pairwise comparisons between the groups: GLP-1 RA vs SGLT2i, combination vs GLP-1 RA, and combination vs SGLT2i, using propensity score matching.
O
Outcome
AF recurrence, defined as repeat catheter ablation, cardioversion, or antiarrhythmic drug use after a 3-month blanking period.composite

Main Result

Hazard Ratio: 1.01 (95% CI 0.89–1.15)

p-value: p=0.86

While GLP-1 RA and SGLT2i alone or in combination have similar effects on AF recurrence after catheter ablation, combination therapy is associated with significantly lower all-cause mortality.

Cite This Study

Ramadan et al. (2026) conducted a cohort in Atrial fibrillation. GLP-1 RA vs. SGLT2i was evaluated on AF recurrence, defined as repeat CA, cardioversion, or antiarrhythmic drug use after a 3-month blanking period (HR 1.01, 95% CI 0.89-1.15, p=0.86). GLP-1 RA vs SGLT2i showed similar AF recurrence after catheter ablation (HR 1.01; 95% CI 0.89-1.15), but combination therapy was associated with lower all-cause mortality than either alone.

synapsesocial.com/papers/6aacf6aa0c46fbdff987ddb2https://doi.org/10.1016/j.hrthm.2026.09.018
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