Abstract of the day - Do GLP-1RAs impact on outcomes in patients with obesity undergoing catheter ablation for AF?
30 Aug 2024
Abstract of the Day Today, Doctor Harsh Patel (Southern Illinois University - Springfield, USA) presents a study investigating the impact of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on outcomes in a large cohort of patients with obesity undergoing catheter ablation for atrial fibrillation (AF).
The study analysed data from 5,260 adult patients with obesity who underwent AF ablation between 2015 and 2022, identified via the TriNetX research network. Using propensity-score matching, patients were categorised according to receipt of a GLP-1RA (liraglutide, exenatide, dulaglutide or tirzepatide) or no GLP-1RA.
The use of GLP-1RAs was associated with a significantly reduced risk of the primary endpoint, a composite of cardioversion, initiation of new antiarrhythmic drug therapy or re-do AF ablation (adjusted odds ratio 0.73; 95% CI 0.65 to 0.82; p<0.001). After 12 months, patients receiving GLP-1RAs vs. no GLP-1RAs had a lower likelihood of events (60.6% vs. 67.7%; hazard ratio [HR] 0.76; 95% CI 0.71 to 0.81; p<0.001). In addition, GLP-1RAs were associated with a significant reduction in AF readmissions (24.7% vs. 28.3%; p<0.001), heart failure readmissions (2.73% vs. 3.65%; p<0.001) and all-cause mortality (2.31% vs. 3.23%; p=0.004), but not in ischaemic stroke readmissions (0.57% vs. 0.79%; p=0.31). In a subgroup analysis of morbidly obese patients (body mass index >40 kg/m2), those on GLP-1RAs showed significantly lower incidence of the primary endpoint (41.9% vs. 53.8%; HR 0.69; 95% CI 0.60 to 0.78; p=0.002).
The authors conclude that their results highlight the potential role of GLP-1RAs in reducing arrhythmia recurrence post-AF ablation in obese patients, possibly through atrial remodelling due to weight loss, pulmonary vein arrhythmogenesis reduction and improved calcium homeostasis.
