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2026 AF Symposium: GLP-1 Improved Post Ablation A-Fib
7-14-26 10pm corrected missing link. | In my last 2026 AF Symposium report, I share with you one of the most impressive research findings of my reports. Potentially a new effective antiarrhythmic drug—and a new antiarrhythmic medication that works!
At this year’s AF Symposium, Dr. Gianluca Iacobellis (University of Miami, FL) gave a presentation entitled “The Role of GLP-1 RA on AF and AF Ablation Outcomes.”
GLP-1s (brand names Ozempic, Wegovy, Mounjaro, Victoza, and Zepbound) are primarily approved for type 2 diabetes management, but are also approved for chronic weight management.
Dr. Iacobellis presents findings from The Liraglutide Effects in Atrial Fibrillation (LEAF) Study. Researchers were looking to improve outcomes for persistent A-Fib patients undergoing catheter ablation. The objective was to test adjunctive therapy for three months pre-ablation with GLP-1 Liraglutide along with Risk Factor Modification for weight loss (typically includes changing lifestyle habits like diet and exercise, improving sleep and stress, and managing underlying conditions with medical support).
One goal was reduction in recurrent A-Fib at one-year. …>Continue reading for the remarkable findings. Go to me full report…>
GLP-1 Receptor Agonists Can Improve Post-Ablation A-Fib
2026 AF Symposium
GLP-1 Receptor Agonists Can Improve Post Ablation A-Fib
Gianluca Iacobellis MD, PhD
At this year’s AF Symposium, Dr. Gianluca Iacobellis (University of Miami, FL) gave a presentation entitled “The Role of GLP-1 RA on AF and AF Ablation Outcomes.” [These are findings from The Liraglutide Effects in Atrial Fibrillation (LEAF) Study.]
[RA stands for Receptor Agonists. An agonist is a substance that binds to a cell receptor and triggers a biological response like a hormone or neurotransmitter.
GLP-1 Agonist Medications
A GLP-1 (Glucagon-Like Peptide) works by reducing blood sugar, improving insulin response, and reducing appetite. GLP-1s (brand names Ozempic, Wegovy, Mounjaro, Victoza, and Zepbound) are primarily approved for type 2 diabetes management, but are also approved for chronic weight management.]
Study Objectives
Background: Obesity and epicardial adipose tissue (EAT) [visceral fat of the heart] are associated with mediocre outcomes in Persistent A-Fib patients undergoing catheter ablation. Epicardial adipose tissue inflammation contributes to cardiovascular disease and Atrial Fibrillation.
Risk factor modification (RFM), including weight loss, improves A-Fib treatment outcomes. Use of the GLP-1, Liraglutide (Victoza), leads to both weight loss and EAT reduction.
The study objective was to test adjunctive therapy for three months pre-ablation with Liraglutide in A-Fib patients undergoing catheter ablation.
Goals: Researchers were looking for a change in left atrial EAT volume and secondarily, reduction in recurrent A-Fib at one-year.
Study Design
For three months pre-ablation, patients’ epicardial adipose tissue (EAT) was evaluated with serial CT scans at enrollment and pre-ablation; Serial echocardiograms were taken up to one-year post-ablation.
Participants: Of the 47 patients participating, 80% had Persistent A-Fib. For the three months prior to their ablation, patients were divided into two groups:
Group 1, 28 overweight/obese patients were assigned to Risk Factor Modification (RFM) counseling alone;
Group 2, 31 overweight/obese patients were assigned to Risk Factor Modification plus received the GLP-1 Liraglutide (RFM+L).
Study Results: One-Year Post-Ablation Significant Freedom in A-Fib Recurrence
At the one-year follow-up, the study catheter ablation patients had no significant difference in weight loss between the two groups.
The significant difference post-ablation was in A-Fib/Flutter (AF/AFL) recurrence. The RFM+L group experienced a 92% one-year reduction in A-Fib/Flutter recurrence, while the RFM group experienced a substantially lower 54% reduction.
In addition, post-ablation Inflammation, particularly in the epicardial adipose tissue, was significantly reduced and contributed to lower recurrence as well.
Study Findings Include Cardiovascular Benefits
Short term, use of a GLP-1 reduced weight by as much as 17% at 3 months and 22% at 6 months.
GLP-1 can also provide cardiovascular effects such as reducing risk of heart attack, stroke, and cardiovascular death. A GLP-1 affects heart and myocardial tissues by reducing inflammation.
Researchers Conclusion: GLP-1 use prior to catheter ablation may provide novel pharmacological use for A-Fib treatment that can substantially improve A-Fib ablation one-year outcomes.
Dr. Iacobellis succinctly concluded, “We should add GLP-1s to prevent and treat AF.”
Editor’s Comments
Editor’s CommentsStudy achievements: Weight loss is an important factor to the success of catheter ablation long-term.
But the study’s remarkable results for the patients with Atrial Fibrillation were:
▪ one-year reduction in A-Fib recurrence by 92%
▪ significantly reduced inflammation in the visceral fat of the heart
Traditional Antiarrhythmic Drugs: Today’s antiarrhythmic meds are older drugs. For example, Flecainide was first developed in 1972 and FDA approved for A-Fib in 1985, that’s over 40 years ago! In general, research studies prove today’s antiarrhythmic meds often don’t work for many patients or lose their effectiveness over time, and often have bad side effects.
GLP-1: a New Antiarrhythmic Med? We are particularly grateful to Dr. Iacobellis and his colleagues for their research (The Liraglutide Effects in Atrial Fibrillation (LEAF) Study). Essentially, they may have discovered a new, effective antiarrhythmic drug—GLP-1—and a new antiarrhythmic medication that works!
Though losing weight is important, being able to treat and even prevent A-Fib recurrence after ablation with a GLP-1 is even more consequential.
Obviously, more extensive research needs to be done. The next steps may be a larger group study and a study comparing one of the traditional antiarrhythmic drugs like Flecainide to the use of GLP-1 therapy.
GLP-1s may be a whole new ball game when it comes to treating Atrial Fibrillation!
(A-Fib Patients, are you curious if you might reap similar benefits from the GLP-1 Liraglutide? One way you might qualify for a prescription through your drug coverage provider is if you have diabetes. Perhaps, you can discuss this with your doctor.)
2026 AF Symposium Spotlight—How Hospitals Are Using AI for Patient Remote Monitoring
At the 2026 AF Symposium Spotlight Session–New and Emerging Technologies in EP, Dr. Babak Bozorgnia (Lehigh Valley Health Center, Allentown, PA) gave a presentation on using AI (Artificial Intelligence) in actual clinical practice.
Dr. Babak Bozorgnia
His talk “A Practical Guide to AI in EP Remote Monitoring: Workflow, Evidence, and Impact” was unusual in that he did not promote a particular AI system or device. Instead he explained in general the uses and advantages of AI to better help cardiac patients.
Implementing Remote Monitoring
In Allentown, PA, there are 11 hospitals. In caring for their many cardiac patients, they use 8,000 devices (such as heart monitors) which all have to be monitored.
In 2019 the Allentown hospitals implemented remote monitoring.
Current Workflow Problems: The EP doctors and staff were overwhelmed with massive amounts data. With the crush of data, they were unable to consistently maintain services…-> continue to read how this was causing staff burnout among other problems until they turned to an Artificial Intelligent platform->
2026 AF Symposium Presentation ballroom: panel discussion underway with presenters
2026 AF Symposium Challenging Cases in AF Management and Stroke Prevention
This is one of my personal favorite sessions, though it’s also one of the least attended (probably because people are leaving early to catch a plane home on the last day of the Symposium).
In this Saturday afternoon session, doctors talk about their most difficult and challenging cases with honesty and humility. Presentations were 5 minutes long followed by 5-minute discussions.
91-year-old Tennis Player with Huge Left Atrial Appendage Opening
Rodney Horton, MD
Dr. Rodney Horton presented the challenging case of a 91-year-old man with persistent A-Fib who lead a very active life. He played tennis dally. (The patient wanted to get off of anticoagulants because of his energetic lifestyle and because he didn’t like being dependent on anticoagulants.
The Problem: The opening (ostium) of his Left Atrial Appendage (LAA) was immense. Dr. Horton described it as “huge and pretty scary looking.” No existing LAA closure device was big enough to close off his ostium. Read about Dr. Horton’s creative, innovation solution to restore this man’s active lifestyle->
2026 AF Symposium: Case Transmission-Results of Catheter Ablation+ Watchman
Concomitant ablation is becoming a standardized or normal practice at many A-Fib centers. I counted 9 sessions and/or cases dealing with concomitant ablation at this year’s AF Symposium. (See also my report on Dr. David Weisman’s live transmission of a Concomitant Ablation using the Nuvision 4-D ICE system.)
Image ACUSON Nuvision 4-D ICE system (stock image)
In a pre-recorded live case we saw Dr. Devi Nair (St. Bernards Healthcare, Jonesboro, AR) performing a Concomitant Ablation in her EP lab in Arkansas. She explained that patients seeking to close off their Left Atrial Appendage (LAA) to prevent stroke are also offered to have their catheter ablation (PVI) performed at the same time.
The 4-D images seemed remarkably vivid and seemed to greatly facilitate the ablation. She did not have to use fluoroscopy. She reported…->Continue reading this short report and my Editor’s Comments->.
2026 AF Symposium Presentation ballroom with panel speakers
2026 AF Symposium: The ADVENT-LTO 4-Year Study of PFA vs. Thermal Ablations
Dr. Vivek Reddy
Considering a Catheter Ablation for your Atrial Fibrillation? To make an informed decision of type of catheter ablation, read about the findings from the ADVNT-LTO study that compared the newer Pulsed Field Ablation to RF/Cryo Catheter Ablation.
At the 2026 AF Symposium, Dr. Vivek Reddy (Mount Sinai Medical Center, New York, NY) gave a presentation on “Long Term Outcomes of Pulsed Field Ablation (PFA) versus Standard of Care Thermal Ablation for Paroxysmal Atrial Fibrillation: Primary Results of the ADVENT-LTO Study.
The ADVENT-LTO was a follow-up study to the original The ADVENT study. This nearly 4-year study followed PFA and thermal ablation patients, basically an observational extension of the original ADVENT trial.
PFA Versus Thermal Ablation
Researchers used Holter monitors, patients’ clinical records, and quality of life surveys to conduct the study.
The primary end point was freedom from recurrence beyond the 3-month blanking period, cardioversions, or repeat ablations.
The PFA group included 183 patients, the thermal ablation group included 181 (81 RF ablation patients and 100 Cryo ablation patients)…Continue reading to learn the study findings and what it means to Atrial Fibrillation patients->
The exhibition hall at the AF Symposium with manufacturers specializing in ablation catheters, LAA closure devices, and mapping systems, as featured in the sessions.
2026 AF Symposium Live Case: Combining PVI with Watchman Device
A Concomitant Ablation combines a Pulmonary Vein Ablation and installation of a Watchman occlusion device in the Left Atrial Appendage (LAA) in one procedure. While once considered innovative or somewhat unusual, it’s no longer so. Instead, at many A-Fib centers it’s a standardized or normal practice.
At the 2026 AF Symposium, I counted 9 sessions and/or cases dealing with concomitant ablation.
In this live case transmission, Symposium attendees observed Dr. David Weisman, Jupiter Medical Center Physicians Group, Jupiter, FL, as he performed a concomitant ablation on a 76-year-old woman with very symptomatic paroxysmal A-Fib who had failed multiple antiarrhythmic drug therapies.
In her case, Dr. Weisman was looking for an alternative to oral anticoagulation, hence the Watchman device. Continue reading about this live transmission using the Nuvision 4D Intracardiac Echocardiography (ICE) ultrasound catheter. —>
2026 AF Symposium—Late Breaking Clinical Science: ADVENT-LTO Study
2026 AF Symposium
Late Breaking Clinical Science: ADVENT-LTO Study
Dr. Vivek Reddy
In the Late Breaking Clinical Science, Session 2, Dr. Vivek Reddy (Mount Sinai Medical Center, New York, NY) gave a presentation on “Long Term Outcomes of Pulsed Field Ablation (PFA) versus Standard of Care Thermal Ablation for Paroxysmal Atrial Fibrillation: Primary Results of the ADVENT-LTO Study.”
ADVENT-LTO Follow-up to ADVENT
The original ADVENT study found that Pulsed Field Ablation (PFA) was “not inferior” [no better or worse] than Thermal Ablation.
The ADVENT-LTO was a follow-up study to the original study. (They were able to re-enroll 60% of the original ADVENT study PFA patients.)
The ADVENT-LTO study followed PFA and thermal ablation patients for nearly 4 years (3.6 years). Basically, they performed an observational extension of the original ADVENT trial.
PFA Versus Thermal Ablation
Researchers used Holter monitors, patients’ clinical records, and quality of life surveys to conduct the study.
The primary end point was freedom from recurrence beyond the 3-month blanking period, cardioversions, or repeat ablations.
The PFA group included 183 patients, the thermal ablation group included 181 (81 RF ablation patients and 100 Cryo ablation patients). There was a 3.6-year follow-up.
ADVENT-LTO Study Findings
Recurrence: Both groups had similar recurrence rates. Overall, 9% of ablation patients will experience recurrence. There was a trend for PFA to be more successful, but it didn’t achieve statistical superiority (an 8-point improvement). The PFA recurrence rate was 9.3%.
Hospital Intervention/Repeat Ablations: PFA patients had fewer hospital-based arrhythmia interventions and repeat ablations. Freedom from intervention in the PFA group was 85.6%, compared to 78.6% for thermal ablation.
Repeat ablation occurred in 10.4.% of PFA patients, compared to 17.7% for thermal ablation.
Drug/Safety Issues: There was reduced anti-arrhythmic drug use in the PFA group, and no long-term safety concerns.
AF Progression: There was less progression from Paroxysmal to Persistent A-Fib in the PFA patients.
Conclusion: PFA Superior to and Preferred Over Thermal Ablation
PFA was found to be superior to thermal ablation, though not statistically significant, the data and trends were meaningful and consequential.
Researchers concluded that coupled with the safety advantages of PFA over thermal ablation, the long-term data supports widespread adoption of PFA for the treatment of Atrial Fibrillation.
Editor’s Comments
Though the findings did not prove statistically significant, the trends are quite revealing. More research is needed with larger numbers of patients.
PFA Superior to Thermal Ablation: The first ADVENT study showed only that PFA was “non-inferior”(not better or worse) to thermal ablation. Not so with the ADVENT-LTO study findings.
Though the ADVENT-LTO study findings did not achieve statistical significance, the trends and data indicate that PFA is superior to thermal ablation.
Kudos to Dr. Reddy: We are very grateful to Dr. Reddy and his colleagues for this important study.
What This Means to Patients: From the follow-up ADVENT-LTO study findings, we patients should prefer PFA over thermal ablation. If you have a choice, select PFA ablation. According to the researchers in ADVENT-LTO, long-term data supports the choice of PFA to treat your Atrial Fibrillation.
Return to 2026 AF Symposium Reports
or Archive of AF Symposium Reports
2026 AF Symposium: Challenging Cases in AF Management & Stroke Prevention
2026 AF Symposium
Challenging Cases in AF Management and Stroke Prevention
Challenging Cases in AF Management and Stroke PreventionThis is one of my personal favorite sessions, though it’s also one of the least attended (probably because people are leaving early to catch a plane home on the last day of the Symposium).—
In this Saturday afternoon session, doctors talk about their most difficult and challenging cases with honesty and humility. Presentations were 5 minutes long followed by 5-minute discussions. The presenters this year were:
David Keane, MD, Moderator
Dr. David Keane (St. Vincent’s Hospital, Dublin, Ireland), Moderator
Dr. John Day (St. Mark’s Hospital, Salt Lake City, Utah)
Dr. Edward Gerstenfeld (University of California, San Francisco, CA)
Dr. Young-Hoon Kim (Korea University Medical Center, Seoul, Korea)
Dr. Laurent Macle (Montreal Heart Institute, Montreal, Canada)
Dr. Francis Marchlinski (University of Pennsylvania, Philadelphia, PA)
Dr. Rodney Horton (Texas Cardiac Arrhythmia Center, Austin, TX)
91-year-old Tennis Player with Huge Left Atrial Appendage Opening
Rodney Horton, MD
Dr. Rodney Horton presented the challenging case of a 91-year-old man with persistent A-Fib who lead a very active life. He played tennis dally. (Dr. Horton said he thought this 91-year-old man could probably beat him in tennis.) The patient wanted to get off of anticoagulants because of his energetic lifestyle and because he didn’t like being dependent on anticoagulants. Also, he didn’t want an atrial clip occlusion device.
The Problem: The opening (ostium) of his Left Atrial Appendage (LAA) was immense. Dr. Horton described it as “huge and pretty scary looking.” No existing LAA closure device was big enough to close off the opening to his LAA.
Amplatzer Amulet & Meltzer knot (stock images)*
Strategy: Off-Label Innovative Closure Device
To modify the man’s ostium, Dr. Horton had to use an off-label hybrid strategy he developed. As a model, he used a condom filled to 43mm.
He used both a lobe of an Amplatzer Amulet device combined with a plastic suture loop in a Meltzer knot. It worked! And effectively closed off the patient’s LAA.
Editor’s Comments
Editor’s CommentsOne has to admire Dr. Horton’s creative and innovative thinking, and his persistence. The alternative was to leave this active 91-year-old tennis player on heavy-duty anticoagulation for life.
This would have directly affected his Quality of Life (QoL), an important consideration in the treatment of patients with Atrial Fibrillation. This patient is fortunate to have found Dr. Horton and his innovative solution that allowed him to return to his very active life. (*BTW: Patti was fascinated by this solution and looked up what a Meltzer knot was and made the illustration.)
Return to 2026 AF Symposium Reports
or Archive of AF Symposium Reports
Pre-recorded Case Transmission—Results of Concomitant Ablation (Catheter Ablation+Watchman Device) in 209 Patients
2026 AF Symposium
Pre-recorded Case—Results of Concomitant Ablation (Catheter Ablation+Watchman Device) in 209 Patients
Pre-recorded Case—Results of Concomitant Ablation (Catheter Ablation+Watchman Device) in 209 PatientsConcomitant ablation is becoming a standardized or normal practice at many A-Fib centers. I counted 9 sessions and/or cases dealing with concomitant ablation at this year’s AF Symposium. (See also my report on Dr. David Weisman’s live transmission of a Concomitant Ablation using the Nuvision 4-D ICE system.)
Dr. Devi G Nair
Dr. Devi Nair (St. Bernards Healthcare, Jonesboro, AR) gave a pre-recorded case presentation on “Concomitant Farawave PVI and Watchman LAA Closure Using Siemens 4-D ICE Catheter.”
PVI Offered Along with LAA Closure
During the pre-recorded procedure, we saw Dr. Nair performing a Concomitant Ablation in her EP lab in Arkansas. She explained that patients seeking to close off their Left Atrial Appendage (LAA) to prevent stroke are also offered a catheter ablation (PVI) at the same time.
The 4-D images seemed remarkably vivid and seemed to greatly facilitate the ablation. She did not have to use fluoroscopy.
Results of Concomitant Ablation: Safe & Effective
Image ACUSON Nuvision 4-D ICE system (stock image)
Dr. Nair discussed the results of performing Concomitant Ablation on 209 patients.
Her success rate in installing the Watchman was 100% with 94% of patients only needing the standard size Watchman. [There are different sizes of Watchman devices to fit the varying shapes and volume of LAAs].
Patients were checked for safety at 30 days and were followed up for 920 days. A CT scan was performed as follow-up in 80% of patients. There were no LAA leaks over 2mm.
Dr. Nair concluded that Concomitant Ablation was not just viable but contributed to effective workflow.
Editor’s Comments
Concomitant Ablation Successful in a Large Group of Patients: Dr. Nair added to Dr. Weisman’s work by showing how Concomitant Ablation was successfully done in a large group of over 200 patients.
Concomitant Ablation Easy to Do: Concomitant Ablation is feasible, practical, and, in Dr. Nair’s work, has been successful with many patients.
In both Dr. Weisman’s and Dr. Nair’s research, 4-D imaging seems a striking improvement over current visualization systems.
What Patients Need to Know: Concomitant Ablation should now be a valid option patients may choose. If you need an ablation and a Watchman occlusion device, why undergo two separate procedures?
Don’t Settle for Less. If your doctor wants you to do two separate procedures, get a second opinion about getting them done at the same time.
(See also my report on Dr. David Weisman’s live transmission of a Concomitant Ablation using the Nuvision 4-D ICE system.)
