Impact of GLP-1 Receptor Agonist Therapy on Atrial Fibrillation Recurrence After Catheter Ablation in Obese Patients: A Real-World Data Analysis

BACKGROUND: GLP-1 (glucagon-like peptide-1) receptor agonists (GLP-1RAs), initially developed for glycemic control in type 2 diabetes, have shown cardiometabolic benefits including weight loss, improved endothelial function, and reduced inflammation. Recent data suggest potential anti-arrhythmic effects via modulation of atrial substrate and autonomic tone. Their impact on obese, nondiabetic patients remains underexplored. This study examines whether GLP-1RA use is associated with reduced atrial fibrillation recurrence after catheter ablation in obese patients, using real-world data from a large multicenter database. METHODS: We conducted a retrospective cohort study using the TriNetX research network, which contains de-identified electronic health records from >100 million patients. Adult patients (age ≥18 years) with obesity (body mass index >30 kg/m²) who underwent atrial fibrillation (AF) ablation between January 2015 and January 2025 were eligible. The cohort was divided into GLP-1RA users (n=3350) and nonusers (n=3350), with 1:1 propensity score matching performed across 82 clinical and demographic variables, including age, sex, race, AF subtype, cardiovascular comorbidities, and baseline medications. RESULTS: During a median follow-up of 2 years (interquartile range, 0.8–3.2) AF recurrence was significantly lower in GLP-1RA users versus non users (6.66% versus 7.72%; hazard ratio [HR], 0.82 [95% CI, 0.76–0.88]; P <0.0001) Progression to permanent AF occurred less frequently in GLP-1RA users (3.16% versus 3.38%; HR, 0.77 [95% CI, 0.63–0.93]; P =0.01). Risk of all-cause mortality was lower in the GLP-1RA group (HR, 0.73 [95% CI, 0.59–0.91]; P =0.01) HF hospitalization (HR, 0.80 [95% CI, 0.71–0.90]; P <0.0001) and cardiovascular hospitalizations (HR, 0.85 [95% CI, 0.77–0.93]; P =0.001) were also significantly lower with GLP-1RA use. No significant difference was found for redo ablation. CONCLUSIONS: In a large real-world cohort of obese patients undergoing catheter ablation for AF, GLP-1RA therapy was associated with lower risks of AF recurrence, progression to permanent AF, cardiovascular hospitalizations, and mortality.