The Liraglutide Effects in Atrial Fibrillation (LEAF) Study

Area of Science:

• Cardiology
• Endocrinology
• Pharmacology

Background:

• Atrial fibrillation (AF) ablation outcomes are suboptimal, especially for persistent AF.
• Obesity and epicardial adipose tissue (EAT) negatively impact AF and ablation success.
• Risk factor modification (RFM), including weight loss, enhances AF treatment efficacy.

Purpose of the Study:

• To evaluate the efficacy of liraglutide as an adjunctive therapy in patients with AF undergoing catheter ablation.
• To assess the impact of liraglutide on epicardial adipose tissue (EAT) and AF recurrence.

Main Methods:

• Randomized study involving overweight/obese patients with AF undergoing catheter ablation.
• Patients received either RFM alone or RFM plus liraglutide (RFM+L) for 3 months preablation.
• Epicardial adipose tissue (EAT) volume, total EAT, and AF recurrence at 1 year were assessed.

Main Results:

• Liraglutide therapy did not significantly alter early weight loss or left atrial epicardial adipose tissue (LAEAT) reduction compared to RFM alone.
• One-year freedom from AF/atrial flutter was significantly higher in the RFM+L group (81%) versus the RFM group (54%).
• RFM+L was associated with a reduced risk of 12-month AF recurrence, with changes in EAT density also correlating with lower recurrence rates.

Conclusions:

• Adjunctive liraglutide therapy to RFM in obese AF patients improved freedom from AF/atrial flutter post-ablation.
• Glucagon-like peptide-1 receptor agonist pleiotropic effects may offer novel therapeutic strategies for AF.
• Liraglutide holds promise for substantially improving AF ablation outcomes, warranting further investigation.