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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.)
Get Your COVID-19 Virus Booster Shots: A-Fib Patients at Higher Risk
COVID-19 (caused by the coronavirus SARS-CoV-2) typically is a threat to the lungs, but it also can worsen any existing cardiovascular disease.
Atrial Fibrillation and COVID-19 are a common and potentially a lethal combination.
Comorbid Conditions Increase Fatality Rate
Many A-Fib patients also suffer from other chronic conditions such as diabetes and hypertension. With comorbid conditions, COVID-19 can increase the severity and fatality of the virus.
“Comorbid” means the simultaneous presence of two chronic diseases or conditions in a patient.
According to research from the Chinese Center for Disease Control and Prevention (CCDC), COVID-19 patients with no comorbid conditions had a case fatality rate of 0.9%. Conversely, patients with the following comorbid conditions had much higher fatality rates:
+ 10.5% for those with cardiovascular disease
+ 7.3% for diabetes
+ 6.3% for chronic respiratory disease
+ 6.0% for hypertension
+ 5.6% for cancer.
Among critical cases, the case fatality rate is unsurprisingly highest at 49%.
Worsening of Existing A-Fib
Developing A-Fib is a common occurrence for those striken with the COVID-19 virus.
For those of us with pre-existing A-Fib, COVID-19 can exacerbate our Atrial Fibrillation. COVID-19 causes an inflammatory response and puts stress on the heart which can lead to:
• More frequent A-Fib episodes
• Increased severity of symptoms
• Greater risk of complications, such as stroke
COVID19 enhances “thrombo-inflammation”, a vicious, self-amplifying cycle where blood clotting (thrombosis) and immune-driven inflammation continuously trigger one another which intensifies coagulation and may increase the risk of cardiac embolism in patients with A-Fib.
You Must Stay Current with Your COVID-19 Booster Shot
Because of higher risk, Atrial Fibrillation patients need to stay current with their COVID-19 booster shots.
Locally, Patti and I visit our CVS drug store to get our booster shots, then we report the information to our doctor (the pharmacy also sends in a report).
Make it a Family Affair
Act Today! Ask your healthcare professional to check if you and your family are current with your COVID-19 booster. And if not, ask about scheduling an appointment or where to go locally to get your booster. You owe it to your family!
It’s a preventative step to avoid the high cardiovascular risk of having A-Fib combined with getting a SARS-CoV-2 infection.
2025 AF Symposium New Report: Weight Loss Drugs and A-Fib
Many A-Fib patients are overweight and also suffer from sleep apnea and hypertension.
At the 2025 AF Symposium, Dr. Donna Ryan of Louisiana State University, Baton Rouge, Louisiana gave a talk on GLP-1 Agonists and their role in treating A-Fib.
She offers insight into how obesity affects a patient’s Atrial Fibrillation. And how today’s GLP-1 agonists (like brand names Ozempic, Mounjaro and Victoza) may go beyond helping with weight loss and can also help improve sleep apnea and/or high blood pressure.
To read my new report, go to: Weight Loss Drugs and A-Fib
GLP-1 Agonist Medications
2025 AF Symposium: Weight Loss Drugs and A-Fib
2025 AF Symposium
Weight Loss Drugs and A-Fib
Donna Ryan, MD
Dr. Donna Ryan of Louisiana State University, Baton Rouge, Louisiana gave a talk on GLP-1 Agonists and their role in treating A-Fib. “The Role of GLP-1 Agonists in Patients with Atrial Fibrillation.”
GLP-1 Agonists
GLP-1 agonists are medications (such as brand names Ozempic, Mounjaro and Victoza) used to treat type 2 diabetes and obesity. They work by mimicking the hormone GLP-1 which helps regulate blood sugar levels and promote satiety. They stimulate the pancreas to release insulin, slow down digestion, and reduce appetite.
GLP-1 agonists are not new. They were first developed over 20 years ago. Exenatide (Byetta) was first produced in the 1990s. (It was FDA approved in 2005.) Dr. Ryan pointed out that GLP-1 agonists may be a particularly good therapy, not just for weight loss but for other health problems as well.
GLP-1 Medications
Liraglutide (Victoza) in 2016 was the first GLP-1 to demonstrate cardiovascular risk reduction.
GLP-1 Agonist Medications
Semaglutide (Ozempic) in 2022 captured the public’s imagination because it produced an average 15% weight loss and it reduced major adverse cardiovascular events (MACE).
Tirzepatide (Mounjaro) in 2023 was found to produce a 23% average weight loss.
Dr. Ryan showed how GLP-1 agonists have other disease modifying properties besides weight loss [or perhaps because of weight loss] such as kidney disease, sleep apnea, major adverse cardiovascular events, etc.
How GLP-1 Agonists Work
GLP-1 agonists increase insulin, manage glycemia (glucose in the blood), help in losing weight, have powerful anti-inflammatory effects, lower blood pressure, decrease appetite, help the kidneys, and improve platelet coagulation.
GLP-1 Research and A-Fib Remission
Dr. Ryan discussed research from Dr. Prashanthan Sanders from Australia in which patients who bought into his weight loss and exercise program not only lost weight but in some cases lost their A-Fib [see my post: Pre-Ablation Fitness Prevents Recurrence of Atrial Fibrillation]. But she acknowledged that it’s often difficult to achieve weight loss in routine medical practice.
How Obesity Impacts a Patient’s A-Fib
She also talked about how obesity impacts a patient’s A-Fib and is the second biggest risk factor (after hypertension) for developing and staying in A-Fib. According to Dr. Ryan obesity in A-Fib patients:
• increases the incidence of A-Fib
• expands the rate of progression
• increases the severity of A-Fib symptoms
• decreases the success of rhythm control strategies
• and increases the risk of worse outcomes
Editor’s Comments
Many A-Fib patients are overweight and also suffer from sleep apnea and hypertension.
Dr. Ryan’s presentation offers insight into how today’s GLP-1 agonists may go beyond helping with weight loss. A GLP-1 can also help improve sleep apnea and/or high blood pressure.
What A-Fib Patients Should Know: If you are carrying extra weight, talk to your cardiologist and your family doctor about using a GLP-1. If you also have sleep apnea and/or high blood pressure, a GLP-1 may help you improve your cardiac health and these other ailments.
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Last updated: Monday, March 17, 2025
Catheter Ablation Superior in Relieving Anxiety/Depression in A-Fib Patients and Improves Quality of Life
In an important study from Australia, Dr. Jonathan Kalman and colleagues from Royal Melbourne Hospital found that catheter ablation was better than medical drug therapy alone in relieving an A-Fib patient’s psychological distress as well as improving physical symptoms and quality of life.
Psychological And Emotional Symptoms of A-Fib
A-Fib often has psychological and emotional symptoms as well as physical. (See my post: Coping with the Fear and Anxiety of Atrial Fibrillation.) These psychological and emotional symptoms make physical symptoms worse.
Psychological distress conditions are independent risk factors for adverse cardiovascular outcomes…and promote A-Fib recurrence, according to an editorial accompanying this Journal of American Medical Assoc. (JAMA) research report, Atrial Fibrillation Catheter Ablation vs Medical Therapy and Psychological Distress: A Randomized Clinical Trial. (Drs. Julia Lurz of Heart Center Leipzig and Karl-Heinz Ladwig of Technical University Munich, Germany). The editorialists urged more awareness of and screening for depression, stress, and anxiety in A-Fib patients.
Randomized Trial
In their study, researchers randomized patients with symptomatic A-Fib to receive either catheter ablation (n=52) or antiarrhythmic medical (drug) therapy (n=48). Patients were followed for 12 months. Ablation patients underwent RF ablation to isolate all pulmonary veins which was achieved in all participants. Additional ablation targets were allowed at the operator’s discretion. A-Fib burden was assessed twice-daily.
Psychological Distress Reduced
Anxiety and depression were significantly reduced in the ablation group.
• Prevalence of severe psychological distress at 12 months: 10.2% after ablation vs 31.9% after medical (drug) therapy
• Hospital Anxiety and Depression Scale (HADS) scores: Anxiety 7.6 vs 11.8 points, and Depression 3.1 vs 5.2 points
• Depression on Beck Depression Inventory-II score was 6.6 vs 10.9 points
In addition, patients were left with an A-Fib burden averaging 0% vs 15.5% after medical (drug) therapy.
Researchers found “…Low AF burden, absence of AF recurrence, and cessation of [antiarrhythmic drug] therapy were all significantly associated with improvements in psychological distress.” And “improvement in psychological symptoms of anxiety and depression was observed with catheter ablation, but not medical therapy.”
Editor’s Comments
Editor’s CommentsCatheter Ablation Reduces Psychological Distress: This is an important, ground-breaking study for us A-Fib patients. Feelings of anxiety, fear, worry, confusion, frustration, depression, and anger often come along with A-Fib and can make our physical symptoms worse. But this Australian study shows that catheter ablation reduces psychological distress by a huge margin compared to medical therapy. (10.2% vs 31.9%).
Doctors May Ignore the Psychological Effects of A-Fib: But all too often when you go to a doctor for A-Fib, they ignore or minimize the psychological and emotional aspects of A-Fib. They are more concerned about your physical symptoms. If that’s the case for you, you need to find on your own a therapist who will acknowledge and treat your psychological distress, even if it might involve antidepressants.
Get a Catheter Ablation for Your Mental Health: This Australian study is all the more reason, if you have A-Fib, to get a catheter ablation as reasonably soon as possible. You will not only feel better with less or no A-Fib burden, but your mental and emotional health will be significantly improved.
NOTE: Dr. Kalman, after reading this report, sent me the following comment, “AF natural history is very variable, and many patients can go for long periods of time with only occasional episodes and minimal Quality of Life impact. For these patients I would not recommend an early ablation… .”
2024 AF Symposium: Spotlight Session: Intranasal Etripamil in AF-RVR: Data on Efficacy for Acute Rate Control (Milestone Pharmaceuticals)
2024 AF Symposium
Spotlight Session: Intranasal Etripamil in AF-RVR: Data on Efficacy for Acute Rate Control (Milestone Pharmaceuticals).
Dr. Jonathan Piccini
Dr. Jonathan Piccini from Duke University Medical Center described a novel nasal medication which could be of major benefit to patients suffering from rapid heart rate Rapid Ventricular Rate (RVR).
Rapid Ventricular Rate is Very Hard on Patients
Rapid Ventricular Rate (RVR) can be very symptomatic, disruptive, and occur far too often for many patients and usually requires visits to the emergency room (ER). But treatment in the ER often doesn’t work well and is costly both for patients and hospitals.
Etripamil Works to Slow Heart Rate and is Self-Administered
Etripamil is a calcium channel blocker (L type) sprayed into the nose for rapid absorption by the nasal mucosa (soft tissue). It works in only 7 minutes. It slows the heart rate and prolongs the refractory period of the AV Node.
It is administered by the patient themselves outside of a health care facility (such as at home).
Etripamil Safe and Effective
In blind placebo trials Etripamil has been found to be safe and effective in patients with both A-Fib and RVR. It is normally administered if the heart rate goes over 100 beats/minute. The average heart rate reduction was 29.91 beats/minute. It lasts for 150 minutes. There was a very low rate of complications. Most importantly, patient satisfaction was significant.
Editor’s Comments
Etripamil Medical Breakthrough! Etripamil is a potential medical breakthrough for patients! Imagine you are having an A-Fib attack where your heart rate goes very high. Instead of running to the ER, you simply spray a medication into your nose which lowers your heart rate by 30% (or more). And it lasts for at least 2 ½ hours.
You now have control over your heart rate which before left you incapacitated, fearful, and feeling terrible. You’re not cured, but at least you can now manage your heart rhythm to a significant extent on your own (at home). You don’t have to rush to your doctor or to a hospital.
Etripamil is a Hopeful Development for A-Fib Patients: Etripamil is probably a long way from getting FDA approval which isn’t guaranteed. But it certainly is a development that is very hopeful for A-Fib patients.
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Last updated: Thursday, July 18, 2024
New “2023 Guideline for the Diagnosis & Management of Atrial Fibrillation”
Links updated: 12-21-23
Important for all A-Fib patients: The newly issued 2023 Guideline for the Diagnosis and Management of Atrial Fibrillation. The guideline includes new evidence to guide your cardiologist and electrophysiologist in the treatment of your Atrial Fibrillation. It was last updated in 2014 and supplemented in 2019.
Cardiologists, electrophysiologists, surgeons, pharmacists, patient representatives and other stakeholders all collaborated on the updated recommendations.
First issued in 1980, the American College of Cardiology (ACC) and the American Heart Association (AHA) develop and publish these guidelines without commercial support, and members volunteer their time to the writing and review efforts.
ACC/AHA develop and publish these guidelines without commercial support, and members volunteer to write and review them.
ACC/AHA/ACCP/HRS: The 2023 Guideline is endorsed by four medical organizations: American College of Cardiology (ACC), American Heart Association (AHA), American College of Clinical Pharmacy (ACCP), and Heart Rhythm Society (HRS).
A Few of the Important Updates for Patients: I am still reading/studying this document—it’s 171 pages long. Here are a few updates that reflect important shifts in the treatment of A-Fib patients:
• Stages of atrial fibrillation: recognizes A-Fib as a disease continuum that requires a variety of strategies at the different stages;
• A-Fib risk factor: recognizes lifestyle and risk factor modification as a pillar of A-Fib management to prevent onset and progression;
• Catheter ablation of A-Fib: can be first-line therapy; Recognizes the superiority of catheter ablation over drug therapy for rhythm control;
• Left atrial appendage occlusion devices: recognized for safety and efficacy.
Steve Ryan at the 2023 AF Symposium
If you read A-Fib.com regularly, you know these topics have filled my posts for years. I write about these topics after reading the newest research, evidence and findings, querying the experts and learn the latest innovations at the annual AF Symposiums from presentations by leading electrophysiologists, cardiologists, scientists and researchers (read my 2023 AF Symposium posts).
I’ll write more about these changes.
You Can Read it Yourself. It’s available on the websites of the American College of Cardiology (JACC.org) and the American Heart Association (ahajournal.org).
Newly released: 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines; Issued by American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines; See www.jacc.org or www.aha.org.
Magnesium Works in ERs to Reduce Risk of A-Fib or Return to Normal Sinus Rhythm
In the United Kingdom, it is common practice in critical care (E.R.) to administer serum magnesium to prevent A-Fib or to return patients to normal sinus rhythm.
This isn’t commonly done in the U.S.
UK ER Study: Magnesium Used in the ER to Prevent A-Fib
Research published in 2022 describes a study done of an adult critical care unit/emergency department (casualty) at the University College London Hospital between January 2016 and December 2017.
This single center observational study examined the preferences of critical nurses using Mg in patients who had undergone non-cardiac surgery.
Of 9,114 opportunities to administer intravenous Magnesium (Mg), there were significant variation practices depending on the individual nurses.
But still, intravenous Mg was associated with a 3% decrease in the relative risk of getting A-Fib after non-cardiac surgery.
Austrian ER Study: IV Magnesium Returns Normal Sinus Rhythm
A study from Vienna, Austria, looked at 2,546 episodes of non-permanent A-Fib in the emergency room (ER). Admission of Intravenous Magnesium (145.8 mg) and Potassium (24 mEq) were compared to no administration of either supplement.
Researchers found that Intravenous Magnesium and Potassium was associated with increased odds of returning patients to normal sinus rhythm (19.2% vs 10.4%) (but didn’t affect A-Flutter.)
Editor’s Comments
Though the above studies differ, they both show that administering Intravenous Magnesium in the ER is an effective tool in avoiding A-Fib or in returning A-Fib patients to normal sinus rhythm.
Some ERs in the U.S. do use Magnesium to return patients to normal sinus rhythm. (But many doctors still consider Magnesium [and most supplements] as little more than snake oil.)
This research is encouraging and indicates that Magnesium can be a useful tool with critical care patients. More research is needed.
What This Means for A-Fib Patients: If you wind up in the emergency room or urgent care for your Atrial Fibrillation, ask if they intend to administer an IV of Magnesium. (If not, why?)
For more about Magnesium, see my article, Cardiovascular Benefits of Magnesium: Insights for Atrial Fibrillation Patients.
Parlay an Ablation to Keep Dementia Away
I have written about studies documenting that A-Fib leads to or causes dementia. How A-Fib doubles the risk of dementia. And that there’s a direct cause and effect relationship, independently relating A-Fib to cognitive decline and dementia.
Good news! A recent research study tells us there’s a way to break that link.
Observational Study: Ablation Reduces Dementia
In a fascinating observational study from Turin, Italy, catheter ablation for A-Fib was associated with a nearly 50% reduction in dementia during a 4.5-year follow-up.
The researchers looked at four observational studies from 2020-2021 that included 40,146 patients of whom 11,312 had catheter ablation for A-Fib.
Compared to patients who developed dementia, they found having a catheter ablation for A-Fib reduced the risk of developing dementia by 50%!
Researchers concluded: ”Correct management of the arrhythmia holds the potential to delay or avoid cognitive decline occurrence.”
Important Research Findings for Patients with A-Fib!
We know that going from A-Fib to normal sinus rhythm increases and improves blood flow to the brain. So it’s intuitive to suppose that improving brain function would reduce the risk of dementia.
A-Fib patients who have a catheter ablation may now add another benefit to becoming A-Fib free, they may also significantly reduce the risk of developing dementia!
Seek Your Cure and a Two-For-One
If you have A-Fib, don’t settle for a life on meds. Don’t just “manage” your A-Fib. Seek your Cure.
A two-for-one! If your path to a cure includes a catheter ablation, you may also be reducing your risk of developing dementia. That’s a double whammy!
