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

Study 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.)

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