Long-Term Impact of GLP-1 Receptor Agonists on AF Recurrence After Ablation in Obese Patients.

Abstract

Background: Obesity is an important risk factor associated with atrial fibrillation (AF). The impact of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) on recurrent AF among patients undergoing catheter ablation is not well described.

Objective: This study aimed to evaluate the effect of GLP-1 RA on the recurrence of AF among obese patients after catheter ablation.

Methods: Utilizing the TriNetX research network, we identified patients aged over 18 with obesity (BMI ≥ 30) who underwent AF ablation from January 1, 2015, to December 1, 2022, using Current Procedural Terminology codes. Patients were categorized based on their baseline GLP-1 RA use. Through propensity-score matching, each cohort comprised 1558 patients. The primary outcome encompassed a composite of cardioversion, initiation of new antiarrhythmic drug (AAD) therapy, or redo AF ablation. Additional outcomes during the 12-month follow-up included AF readmission, heart failure readmissions, readmissions due to ischemic stroke, and mortality, with a separate analysis done for patients with BMI > 40.

Results: GLP-1 RA use in patients with obesity undergoing AF ablation was linked to a significantly reduced risk of cardioversion, new AAD therapy, and the need for redo AF ablation (hazard ratio [HR] 0.72 [0.65-0.80]; p < 0.001). At 12 months, individuals on GLP-1 agonists exhibited a lower likelihood of mortality (HR 0.61 [0.40-0.93]; p < 0.001). Although all other secondary outcomes were lower in the GLP-1 RA group, there was no significant difference in ischemic stroke between the groups. These results were consistent among patients with BMI > 40, although apart from ischemic stroke, there was no difference in mortality between the two groups.

Conclusion: The utilization of GLP-1 RA in individuals with obesity is linked to a decreased likelihood of arrhythmia recurrence following AF ablation, leading to a reduced requirement for cardioversion, AAD therapy, or redo AF ablation.