GLP-1 receptor agonists and risk of early and late recurrence after AF ablation in type 2 diabetes: an analysis from a global federated research network
L Serio, A Askarinejad, C Weng, K Ahmadzadeh, D Gupta, U Alam, C Ferri, G Y H LipAbstract
Background
GLP-1 receptor agonists (GLP-1 RAs) lower cardiovascular risk in type 2 diabetes mellitus (T2DM) and may have additional anti-arrhythmic benefits, including reduced atrial fibrillation (AF) risk. Evidence regarding a protective association between GLP-1 RAs and AF recurrence post- pulmonary vein isolation (PVI) is inconclusive.
Purpose
To assess the association between GLP-1 RA therapy and AF recurrence following PVI.
Methods
Using the TriNetX global federated collaborative research network, we identified adults with T2DM and AF undergoing PVI comparing patients receiving GLP-1-RA vs no GLP-1-RA therapy. Propensity score matching (PSM) was used to balance baseline characteristics. Early and late atrial tachyarrhythmia recurrence were defined as recurrence occurring within the first 2 months (early recurrence of atrial tachyarrhythmia, ERAT) and between 2 and 12 months after ablation (late recurrence of atrial tachyarrhythmia, LRAT), respectively. The primary outcome was LRAT and secondary outcomes included ERAT, all-cause mortality, acute myocardial infarction, major adverse cardiovascular events (MACE), and stroke.
Results
Before PSM, the cohort included 3,352 GLP-1 RA treated patients (mean age 65.0 ± 8.8, 35.5% female) and 16,917 patients not treated (67.3 ± 9.2, 35.5% female). Before PSM, patients in GLP-1 RA group had more comorbidities including hypertension, heart failure, and chronic kidney disease. After PSM, Cox proportional hazards regression demonstrated that GLP-1-RA use was associated with lower ERAT (HR 0.61, 95% CI 0.57–0.64), LRAT (HR 0.88, 95% CI 0.83–0.92). GLP-1-RA therapy was also associated with lower all-cause mortality (HR 0.46, 95% CI 0.34–0.62), MACE (HR 0.73, 95% CI 0.63–0.84), and stroke (HR 0.72, 95% CI 0.58–0.91).
Conclusion
In T2DM patients undergoing AF ablation, GLP-1 RA therapy was associated with lower ERAT and LRAT risk, as well as fewer 1-year cardiovascular events. Prospective randomized studies are needed to confirm these findings and define the role of GLP-1 RAs after PVI.Study timeline and event riskForest plots outcomes pre and post matching