Obesity is associated with higher recurrence rates after catheter ablation for atrial fibrillation (AF). Glucagon-like peptide-1 receptor agonists (GLP-1RAs) promote weight loss and may influence metabolic pathways linked to AF. A single-centre, propensity-matched study published in the EP Eurospace evaluated whether semaglutide was associated with rhythm outcomes following AF ablation in obese patients.

The study included patients with body mass index (BMI) ≥30 kg/m² undergoing first-time catheter ablation for paroxysmal AF between 2019 and 2024. Patients initiating semaglutide within 3 months before or 1 month after ablation were compared with matched controls not receiving GLP-1RA therapy. Continuous rhythm monitoring was performed using implantable cardiac monitors. The primary endpoint was atrial tachyarrhythmia recurrence beyond a 2-month blanking period.

The final cohort included 181 semaglutide-treated patients and 181 matched controls. At 18 months, freedom from recurrence was 80.2% in the semaglutide group compared with 65.2% in controls. Semaglutide use was associated with lower recurrence risk (hazard ratio 0.52; 95% CI 0.34–0.78; p=0.002). Weight and BMI reductions were greater with semaglutide (−11.8±3.8 kg; −4.0±1.4 kg/m²) versus controls (−1.9±1.2 kg; −0.3±0.8 kg/m²; both p<0.001). A substantial proportion achieved ≥10% weight loss. Further studies are needed to confirm these findings.