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

Abstract

ABSTRACT Background 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. Objectives 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. Methods 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 I 2 . Time‐to‐event outcomes were synthesized using reconstructed individual patient data from Kaplan–Meier curves. Results 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; I 2 = 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; I 2 = 46.9%). Conclusion 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.