Long‐Term Impact of GLP‐1 Receptor Agonists on AF Recurrence After Ablation in Obese Patients
Harsh Patel, Aakash Sheth, Ambica Nair, Bhavin Patel, Samarthkumar Thakkar, Bharat Narasimhan, Nishaki Mehta, Zain Ul Abideen Asad, Gurukripa N. Kowlgi, Christopher V. DeSimone, Konstantinos C. Siontis, Sourbha S. Dani, Mohamed Labedi, Abhishek Deshmukh
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.