Effect of GLP-1 Receptor Agonists on Post-Ablation Atrial Fibrillation Recurrence: A Meta‑Analysis

Among patients undergoing catheter ablation for atrial fibrillation (AF), it remains uncertain whether peri- or post-ablation use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) reduces AF recurrence.

We conducted a meta-analysis of observational studies and randomized controlled trials comparing GLP-1 RA therapy versus no GLP-1 RA use on AF recurrence following ablation.

We systematically searched PubMed, Scopus, Web of Science, and Embase for adult randomized and observational studies. Random-effects models generated risk ratios (RRs), and heterogeneity was assessed via I². Time-to-event outcomes were synthesized using reconstructed individual patient data from Kaplan-Meier curves.

Six studies met the inclusion criteria, with four contributing data for Kaplan-Meier curve reconstruction and five included in the hazard ratio (HR) meta-analysis. Across four studies (n = 695; GLP-1 RA = 295; control = 400), pooled Kaplan-Meier curves showed a lower risk of AF recurrence with GLP-1 RA therapy (HR 0.53, 95% confidence interval [CI]: 0.38-0.72), with a restricted mean survival time (RMST) advantage of 1.02 months. A random-effects meta-analysis of five studies confirmed this benefit (HR 0.78, 95% CI: 0.61-0.99; I² = 75%). Pairwise analyses at 12 months demonstrated fewer AF recurrences with GLP-1 RAs (28.6% vs. 32.9%; RR 0.82, 95% CI: 0.76-0.90; I² = 46.9%).

GLP-1 RA therapy was associated with reduced AF recurrence after ablation, but methodological limitations warrant cautious interpretation. Prospective randomized trials are needed to confirm this potential benefit.