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Background <p>Obesity often co-exists with Atrial Fibrillation (AF) and poses challenges to ablation success. 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 remains unclear.</p> Methods <p>We performed meta-analysis and included prior interventional and observational studies that investigated weight loss-related interventions on AF recurrence post-ablation. Included were weight loss interventions that entailed perioperative use of GLP-1 agonists (4 studies), non-pharmacological interventions such as lifestyle/ risk factors modifications (8 studies), and bariatric surgery (1 study). Primary outcome was recurrence of clinical AF or a requirement for further rhythm control post-ablation.</p> Results <p>Two randomized-control trials and 11 cohorts were included (<i>n</i> = 5,415). Overall, weight loss interventions were associated with significant reduction in AF recurrence post-ablation (<i>RR</i> = 0.63 [95% CI: 0.46—0.87]). Bariatric surgery was associated with reduced risk of AF recurrence (<i>RR</i> = 0.31 [0.13 to 0.75]), while GLP-1 agonists and lifestyle /risk factors modifications showed trends towards protection with borderline statistical significance (<i>RR</i> = 0.64 [95% CI 0.36 to 1.14]). However, only 1 study investigated bariatric surgery which should be interpreted with caution. Importantly, meta-regression showed that for each 1% absolute decrease in body weight achieved, there was 6.3% relative-risk reduction in AF recurrence (<i>RR</i> = 0.94 [0.90—0.98]), regardless of weight loss intervention subtype. Sustained continuation of weight loss post-ablation was a determining factor of lower recurrence (<i>P</i> = 0.03).</p> Conclusions <p>Peri-operative weight loss interventions in obesity patients significantly reduced AF recurrence post-ablation, in a dose–response manner and irrespective of choice of intervention strategy. Sustained continuation of weight loss post-ablation is a key determinant of success.</p> Graphical abstract <p>Forest plot for recurrence of AF stratified by interventions. Overall pooled risk ratio (RR) across all weight-loss interventions was 0.64 (95% CI: 0.47–0.87, heterogeneity: <i>I</i>² = 86 &amp; τ2 = 0.23).</p> <p></p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月17日

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  • Hoi-Ying Li,
  • Gregory Y. H. Lip,
  • Tsz-Kwan Chan,
  • Kai-Hang Yiu,
  • Hung-Fat Tse,
  • Claire A. Martin,
  • Yap-Hang Chan

摘要

Background

Obesity often co-exists with Atrial Fibrillation (AF) and poses challenges to ablation success. 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 remains unclear.

Methods

We performed meta-analysis and included prior interventional and observational studies that investigated weight loss-related interventions on AF recurrence post-ablation. Included were weight loss interventions that entailed perioperative use of GLP-1 agonists (4 studies), non-pharmacological interventions such as lifestyle/ risk factors modifications (8 studies), and bariatric surgery (1 study). Primary outcome was recurrence of clinical AF or a requirement for further rhythm control post-ablation.

Results

Two randomized-control trials and 11 cohorts were included (n = 5,415). Overall, weight loss interventions were associated with significant reduction in AF recurrence post-ablation (RR = 0.63 [95% CI: 0.46—0.87]). Bariatric surgery was associated with reduced risk of AF recurrence (RR = 0.31 [0.13 to 0.75]), while GLP-1 agonists and lifestyle /risk factors modifications showed trends towards protection with borderline statistical significance (RR = 0.64 [95% CI 0.36 to 1.14]). However, only 1 study investigated bariatric surgery which should be interpreted with caution. Importantly, 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 weight loss intervention subtype. Sustained continuation of weight loss post-ablation was a determining factor of lower recurrence (P = 0.03).

Conclusions

Peri-operative weight loss interventions in obesity patients significantly reduced AF recurrence post-ablation, in a dose–response manner and irrespective of choice of intervention strategy. Sustained continuation of weight loss post-ablation is a key determinant of success.

Graphical abstract

Forest plot for recurrence of AF stratified by interventions. Overall pooled risk ratio (RR) across all weight-loss interventions was 0.64 (95% CI: 0.47–0.87, heterogeneity: I² = 86 & τ2 = 0.23).