Impact of Glucagon-like peptide-1 receptor agonists on atrial fibrillation recurrence after catheter ablation: a systematic review and meta-analysis

Background Recurrence of atrial fibrillation after catheter ablation remains common, particularly in patients with obesity and adverse cardiometabolic profiles. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as highly effective therapies for weight reduction and cardiometabolic risk improvement, but their effect on post-ablation atrial arrhythmia recurrence remains poorly defined. Purpose This systematic review and meta-analysis aimed to evaluate the effect of GLP-1 RA therapy on atrial fibrillation recurrence after catheter ablation. Methods MEDLINE, Embase and Cochrane databases were systematically searched for randomised controlled trials and observational studies comparing GLP-1 RA therapy versus control in patients undergoing atrial fibrillation ablation. Binary outcomes were pooled as risk ratios (RRs) with 95% confidence intervals (CIs) using the Mantel–Haenszel random-effects model. Continuous outcomes were pooled as mean differences (MDs) with 95% CIs. Statistical analyses were performed using Review Manager (Cochrane Collaboration). Results A total of 1,163 patients from 1 randomised controlled trial and 5 observational studies were included. GLP-1 RA use was associated with a significant reduction in atrial tachyarrhythmia recurrence compared with control (RR 0.70, 95% CI 0.60–0.81; p<0.00001). In a subgroup analysis limited to semaglutide, treatment was also associated with a significant reduction in atrial tachyarrhythmia recurrence (RR 0.59, 95% CI 0.44–0.80; p=0.0006). In addition, the GLP-1 RA group had significantly greater body weight reduction than the control group (MD 5.01 kg, 95% CI 1.48–8.55; p=0.005). Conclusion Among patients undergoing catheter ablation for atrial fibrillation, GLP-1 RA therapy was associated with a lower risk of atrial tachyarrhythmia recurrence and greater weight loss compared with control. Larger randomised trials are needed to confirm these findings and better define the role of GLP-1 RAs in post-ablation rhythm management.