Comparing GLP-1 agonists versus other weight loss interventions on atrial fibrillation recurrence after catheter ablation: a meta-regression analysis

Obesity often co-exists with Atrial Fibrillation (AF) and poses a challenge to the success of AF ablation. Whether glucagon-like peptide-1 (GLP-1) agonists have a role and how they compare to other weight loss interventions in preventing AF recurrence after catheter ablation remained unclear.

To investigate the effect of GLP-1 agonists versus other weight loss interventions on the risk of AF recurrence after ablation in obese patients.

We performed a meta-analysis and included all prior interventional and observational studies that investigated weight loss-related interventions on AF recurrence post-ablation. We included perioperative use of GLP-1 agonists, and non-pharmacological interventions such as weight loss programs, lifestyle/ cardiovascular risk factors modification, and bariatric surgery. A random-effects model using the Mantel-Haenszel method was conducted to derive risk ratio (RR) estimates of AF recurrence (RStudio, version 2024). Meta-regression analyses were conducted to assess the relation of weight loss magnitude with AF recurrence. Primary outcome was defined as the recurrence of clinical AF or a requirement for further rhythm control post-ablation.

Two randomized control trials and 11 cohort studies were included in the final analysis (n=5,364). Overall, weight loss interventions were associated with a significant reduction in AF recurrence post-ablation (RR = 0.63 [95% CI: 0.46 - 0.87], Figure A). In subgroup analyses, bariatric surgery was associated with a significantly reduced risk of AF recurrence (RR = 0.31 [0.13 - 0.75]), while GLP-1 agonists showed a trend towards protection with borderline statistical significance (RR =0.64 [95% CI 0.36 – 1.14]). Importantly, overall meta-regression showed that for each 1% absolute decrease in body weight achieved, there was 6.3% relative risk reduction in AF recurrence (RR = 0.94 [0.90 - 0.98]), regardless of the choice of weight loss intervention (Figure B).

Peri-operative weight loss interventions in obesity patients significantly reduced AF recurrence after catheter ablation, in a dose-response manner and irrespective of the choice of intervention strategy.Figure A  Figure B