Key result
Adjunctive GLP-1 receptor agonists reduce AF recurrence ~30% at 1 year post-ablation.
Why the study?
Atrial arrhythmia recurrence remains common after catheter ablation for AF, and although GLP-1 receptor agonists improve weight loss and cardiometabolic risk, their impact on post-ablation rhythm outcomes in obese or overweight patients remains uncertain.
Do GLP-1 receptor agonists as adjunctive therapy to first-time catheter ablation reduce atrial tachyarrhythmia recurrence at 1 year in obese or overweight patients with atrial fibrillation?
Meta-Analysis (n=7,499)
Do GLP-1 receptor agonists as adjunctive therapy to first-time catheter ablation reduce atrial tachyarrhythmia recurrence at 1 year in obese or overweight patients with atrial fibrillation?
In obese or overweight patients undergoing first-time AF ablation, adjunctive GLP-1 receptor agonist therapy is associated with a 30% relative reduction in 1-year atrial tachyarrhythmia recurrence without increasing procedural complications.
Adjunctive GLP-1 agonists may reduce post-ablation AF recurrence in obese patients; hypothesis-generating from observational data and requires RCT confirmation.
Background Recurrence of atrial arrhythmias remains common after catheter ablation for atrial fibrillation (AF). Glucagon-like peptide-1 (GLP-1) receptor agonists improve weight loss and cardiometabolic risk, but their impact on post-ablation rhythm outcomes remains uncertain. Purpose To evaluate the efficacy and safety of GLP-1 receptor agonists as adjunctive therapy to first-time AF ablation in obese or overweight patients. Methods A systematic search of PubMed, Embase, and Cochrane databases was performed from inception to February 2026. Observational studies comparing GLP-1 therapy plus ablation versus ablation alone were included. The primary endpoint was freedom from atrial tachyarrhythmia recurrence at 1 year beyond a 3-month blanking period. Hazard ratios (HR) and odds ratios (OR) with 95% confidence intervals (CI) were pooled using a random-effects inverse-variance model. Heterogeneity was assessed with the I² statistic. Results Three observational studies (one prospective and two propensity-matched cohort analyses), including 7499 patients (40% female) with AF (paroxysmal: 81.5% vs 79.7%). 3810 patients underwent AF ablation and GLP-1 agonist therapy, and 3689 underwent only AF ablation. Type 2 diabetes mellitus was present in 29% in patients with GLP-1 as adjunct therapy to ablation. The median follow-up was 1.5 years. Combined therapy was significantly associated with higher freedom from atrial tachyarrhythmia recurrence at 12 months compared to the ablation group (HR: 0.70; 95% CI: 0.54 - 0.91; P < 0.01) (Figure 1). Moderate heterogeneity was observed (I² = 65.5%), likely reflecting differences in rhythm monitoring strategies. Complication analyses were exploratory due to low event rates. Persistent AF was less frequent in the GLP-1 group (OR 0.72; 95% CI 0.60 – 0.88; p = 0.001; I² = 0%). Stroke or transient ischemic attack and major vascular complications did not differ significantly between groups (Figure 2). Conclusion In obese or overweight patients undergoing first-time AF ablation, adjunctive GLP-1 receptor agonist therapy appears to be associated with reduced atrial tachyarrhythmia recurrence at 1 year without a significant increase in procedural complications. Prospective randomized trials are warranted to confirm these findings.Figure 1.Primary endpointFigure 2.Secondary endpoints
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Bistriceanu et al. (2026) conducted a meta-analysis in Atrial fibrillation (n=7,499). GLP-1 receptor agonists plus catheter ablation vs. Catheter ablation alone was evaluated on Freedom from atrial tachyarrhythmia recurrence at 1 year beyond a 3-month blanking period (HR 0.70, 95% CI 0.54-0.91, p=<0.01). Adjunctive GLP-1 receptor agonist therapy with AF ablation reduced atrial tachyarrhythmia recurrence at 12 months compared to ablation alone (HR 0.70; 95% CI 0.54-0.91; P<0.01).
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