Atrial fibrillation (AF) ablation is frequently followed by recurrence, particularly in patients with persistent AF and obesity. Epicardial adipose tissue (EAT) and risk factor modification (RFM) are recognized contributors to post-ablation outcomes. A randomized study published in JACC: Clinical Electrophysiology evaluated liraglutide added to RFM in overweight or obese patients undergoing AF ablation.

Eligible participants were adults with AF and body mass index (BMI) ≥27 kg/m², with 80% having persistent AF. Patients were randomized to RFM alone (n=28; mean age 61.8±10.3 years; 8 females) or RFM plus liraglutide (n=31; mean age 62.2±8.6 years; 8 females) for 3 months before ablation. One patient in the RFM group and three in the liraglutide group did not proceed to ablation, and pre-ablation assessments were performed at that stage.

Serial computed tomography (CT) scans measured left atrial EAT (LAEAT) at baseline and pre-ablation, while echocardiography was performed up to one year post-ablation. The primary endpoint was change in LAEAT volume, with total EAT and AF recurrence at one year as secondary outcomes.

Baseline characteristics were comparable between groups (median BMI 34.2–37.2 kg/m²). Reductions in LAEAT (−1.0 [−4.5 to 1.4] mL; p=0.02) and body weight (−2.8±4.0 kg; p<0.001) were observed overall, without significant between-group differences.

One-year freedom from AF/atrial flutter (AFL) was higher in the RFM plus liraglutide group (81%; 95% CI 62–91%) compared with RFM alone (54%; 95% CI 34-70%; p=0.007). In regression analyses, liraglutide use was associated with lower recurrence (OR 0.19; 95% CI 0.05-0.73; p=0.015 and OR 0.08; 95% CI 0.01-0.40; p=0.002). Changes in EAT density were also associated with lower recurrence (OR 0.55; 95% CI 0.36-0.84; p=0.006).

Addition of liraglutide to RFM was associated with higher freedom from AF/AFL at one year, despite no significant differences in early weight loss or LAEAT reduction.