Key result
GLP-1 RA therapy linked to ~12% lower late recurrence after AF ablation in type 2 diabetes.
Why the study?
GLP-1 receptor agonists may have anti-arrhythmic benefits in T2DM, but evidence regarding a protective association with AF recurrence following pulmonary vein isolation was inconclusive.
Does GLP-1 receptor agonist therapy reduce late recurrence of atrial tachyarrhythmia between 2 and 12 months after pulmonary vein isolation in adults with type 2 diabetes mellitus and atrial fibrillation?
Cohort (n=20,269)
Yes
Does GLP-1 receptor agonist therapy reduce late recurrence of atrial tachyarrhythmia between 2 and 12 months after pulmonary vein isolation in adults with type 2 diabetes mellitus and atrial fibrillation?
In patients with type 2 diabetes undergoing atrial fibrillation ablation, GLP-1 receptor agonist therapy is associated with significantly lower risks of early and late atrial tachyarrhythmia recurrence, all-cause mortality, MACE, and stroke at 1 year.
Should not yet change post-ablation care in T2DM; leaves open whether GLP-1 RAs improve outcomes in randomized trials.
Background GLP-1 receptor agonists (GLP-1 RAs) lower cardiovascular risk in type 2 diabetes mellitus (T2DM) and may have additional anti-arrhythmic benefits, including reduced atrial fibrillation (AF) risk. Evidence regarding a protective association between GLP-1 RAs and AF recurrence post- pulmonary vein isolation (PVI) is inconclusive. Purpose To assess the association between GLP-1 RA therapy and AF recurrence following PVI. Methods Using the TriNetX global federated collaborative research network, we identified adults with T2DM and AF undergoing PVI comparing patients receiving GLP-1-RA vs no GLP-1-RA therapy. Propensity score matching (PSM) was used to balance baseline characteristics. Early and late atrial tachyarrhythmia recurrence were defined as recurrence occurring within the first 2 months (early recurrence of atrial tachyarrhythmia, ERAT) and between 2 and 12 months after ablation (late recurrence of atrial tachyarrhythmia, LRAT), respectively. The primary outcome was LRAT and secondary outcomes included ERAT, all-cause mortality, acute myocardial infarction, major adverse cardiovascular events (MACE), and stroke. Results Before PSM, the cohort included 3,352 GLP-1 RA treated patients (mean age 65.0 ± 8.8, 35.5% female) and 16,917 patients not treated (67.3 ± 9.2, 35.5% female). Before PSM, patients in GLP-1 RA group had more comorbidities including hypertension, heart failure, and chronic kidney disease. After PSM, Cox proportional hazards regression demonstrated that GLP-1-RA use was associated with lower ERAT (HR 0.61, 95% CI 0.57–0.64), LRAT (HR 0.88, 95% CI 0.83–0.92). GLP-1-RA therapy was also associated with lower all-cause mortality (HR 0.46, 95% CI 0.34–0.62), MACE (HR 0.73, 95% CI 0.63–0.84), and stroke (HR 0.72, 95% CI 0.58–0.91). Conclusion In T2DM patients undergoing AF ablation, GLP-1 RA therapy was associated with lower ERAT and LRAT risk, as well as fewer 1-year cardiovascular events. Prospective randomized studies are needed to confirm these findings and define the role of GLP-1 RAs after PVI.
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Serio et al. (2026) conducted a cohort in Type 2 diabetes mellitus and atrial fibrillation undergoing pulmonary vein isolation (n=20,269). GLP-1 receptor agonist therapy vs. No GLP-1 receptor agonist therapy was evaluated on Late recurrence of atrial tachyarrhythmia (LRAT), defined as recurrence occurring between 2 and 12 months after ablation (HR 0.88, 95% CI 0.83-0.92). GLP-1 RA therapy was associated with lower late recurrence of atrial tachyarrhythmia 2–12 months after AF ablation in type 2 diabetes vs no GLP-1 RA therapy (HR 0.88; 95% CI 0.83-0.92).
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