Liraglutide plus risk factor modification improves freedom from AF after ablation: LEAF
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Key takeaways:
- Risk factor modification plus liraglutide improved freedom from atrial fibrillation after ablation for adults with obesity compared with risk factor modification alone.
- Longer-term follow-up is continuing.
PHILADELPHIA — Adults with obesity and atrial fibrillation treated with liraglutide plus risk factor modification had improved outcomes after catheter ablation compared with those prescribed risk factor modification alone.
Data suggest weight and weight loss are associated with AF outcomes and that people with obesity and AF have lower success rates after undergoing catheter ablation, Jeffrey Goldberger, MD, MBA, director of the Center for Atrial Fibrillation and professor of medicine and biomedical engineering at UHealth – the University of Miami Health System and the Miami Miller School of Medicine, said during a presentation at the American Heart Association Scientific Sessions. Liraglutide (Saxenda, Novo Nordisk) is a GLP-1 receptor agonist approved by the FDA for weight management for adults with a BMI of 27 kg/m2 or greater who have at least one weight-related condition, such as hypertension or type 2 diabetes.
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Goldberger and colleagues analyzed data from 65 adults with persistent or paroxysmal AF and a BMI of 27 kg/m2 or greater who opted for catheter ablation. All patients underwent a 3-month pre-ablation period and were randomly assigned to standard risk factor modification alone (n = 33) or standard risk factor modification plus liraglutide 1.8 mg daily (n = 32).
The nurse practitioner-led risk factor modification program for weight loss included a review of dietary practices and goal setting with a dietitian, an exercise prescription, sleep apnea evaluation and treatment as necessary, and evaluations for control of type 2 diabetes, hypertension and hyperlipidemia and counseling on alcohol reduction and smoking cessation.
“Risk factor modification was continued in all patients after ablation; patients assigned to the liraglutide treatment group also received the medication for an additional 6 months following ablation,” Goldberger said during the presentation, adding that patients underwent long-term monitoring for recurrent arrhythmias at 6 and 12 months.
Primary endpoints were change in epicardial adipose tissue from enrollment to month zero and freedom from AF or atrial flutter after ablation. Healio previously reported on the interim results of the LEAF trial presented at Heart Rhythm 2023.
Improved freedom from AF, atrial flutter
Of the 59 patients who did not withdraw before ablation, the mean age was 62 years, 27% were women, the mean weight was 106.4 kg, the mean BMI was 36.1 kg/m2 and 79% had persistent AF.
There was significant weight loss in both groups, but the between-group difference in weight loss was not statistically significant, Goldberger said.
Overall, there was a reduction in epicardial adipose tissue thickness from a mean of 9 mm to 8.2 mm, with no difference between groups, Goldberger said.
Researchers did observe a significant difference in freedom from AF and atrial flutter for patients who received risk factor modification plus liraglutide compared with risk factor modification alone. The Kaplan-Meier 1-year estimate of freedom from AF was 83% for risk factor modification plus liraglutide vs. 57% for the risk factor modification-only group (log-rank P = .036.).
Goldberger said follow-up of the cohort is ongoing and additional analyses are pending, including evaluation of changes in weight.
“In a group of obese patients with primarily persistent AF, pre-ablation treatment with risk factor modification and/or risk factor modification plus liraglutide results in weight loss and reduction in epicardial adipose tissue,” Goldberger said. “Improved outcomes were observed from pulmonary vein isolation-based catheter ablation with risk factor modification plus liraglutide compared with risk factor modification only. We therefore conclude that treatment with risk factor modification and GLP-1 receptor agonists may be useful adjunctive therapy for obese patients with AF.”
Data show AF ‘multifactorial disease’
Discussing the LEAF findings, Melissa Middeldorp, PhD, MPH, a postdoctoral researcher at the University Medical Center Groningen, the Netherlands, and at the University of Adelaide, Australia, noted that 3 months “may not be enough time” to discern any significant changes in epicardial adipose tissue between the two groups, and said longer-term follow-up may yield different results. Additionally, Middeldorp said it is important to assess what happens to patients in the liraglutide group after they stop taking the drug, as previous studies with GLP-1 receptor agonists suggest patients typically regain weight within a short time of ceasing the drugs.
“This study demonstrates that AF is a multifactorial disease and it is important that we address these [risk factors] from head to toes,” Middeldorp said. “There is a signal that there may be a rhythm control benefit in AF patients. We did not see a difference between groups in weight loss or epicardial adipose tissue. There may be direct effects on the myocardium that we are not aware of and have yet to be explained. We need larger multicenter randomized controlled trials with longer follow-up to see how the GLP-1 receptor agonists will fit into our field.”
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Goldberger J, et al. FS.06. Exercise is life (and death) - Approaches in athletes, arrhythmias and heart failure. Presented at: American Heart Association Scientific Sessions; Nov. 11-13, 2023; Philadelphia.
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