Atrial fibrillation (AF) recurrence remains frequent in patients with obesity after catheter ablation and is associated with adverse outcomes. In Circulation: Arrhythmia and Electrophysiology, a retrospective cohort study evaluated the association between glucagon-like peptide-1 receptor agonist (GLP-1RA) therapy and AF outcomes following catheter ablation.

The analysis used data from a large multicenter electronic health record network. Adults aged 18 years or older with obesity, defined as a body mass index (BMI) greater than 30 kg/m², who underwent AF ablation between January 2015 and January 2025 were included. The cohort comprised 3,350 GLP-1RA users and 3,350 nonusers. Groups were matched 1:1 using propensity scores across 82 clinical and demographic variables. These variables included age, sex, race, AF subtype, cardiovascular comorbidities, and baseline medications.

During a median follow-up of 2 years (interquartile range [IQR], 0.8-3.2 years), AF recurrence was lower in GLP-1RA users compared with nonusers. Rates were 6.66% versus 7.72%. The hazard ratio (HR) was 0.82 (95% confidence interval [CI], 0.76-0.88; P < 0.0001). Progression to permanent AF occurred less frequently in GLP-1RA users (3.16% vs 3.38%; HR, 0.77; 95% CI, 0.63-0.93; P = 0.01). All-cause mortality was lower (HR, 0.73; 95% CI, 0.59-0.91; P = 0.01). Heart failure (HF) hospitalization (HR, 0.80; 95% CI, 0.71-0.90; P < 0.0001) and cardiovascular (CV) hospitalizations (HR, 0.85; 95% CI, 0.77-0.93; P = 0.001) were also reduced. No significant difference was observed for redo ablation.

In this real-world cohort, GLP-1RA therapy was associated with lower AF recurrence and fewer adverse cardiovascular outcomes after ablation in patients with obesity.