GLP-1 receptor agonists confer better outcomes after AF ablation in patients with diabetes
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Key takeaways:
- Patients with diabetes who underwent AF ablation were compared based on whether they took a GLP-1 receptor agonist.
- Those taking that drug class had reduced risk for AF recurrence and other outcomes.
In patients with type 2 diabetes who underwent ablation for atrial fibrillation, those taking a GLP-1 receptor agonist had lower risk for AF recurrence, mortality and other outcomes, researchers reported at Heart Rhythm 2024.
“Recurrence of AF after ablation is common and happens in 20% to 45% of patients,” Aakash R. Sheth, MD, cardiology fellow at University of Pittsburgh Medical Center (UPMC) Harrisburg, who presented the results, told Healio. “One of the main reasons is comorbidities like hypertension and diabetes. Several preclinical studies ... predominantly done in mice have shown that atrial fibrosis associated with type 2 diabetes is one of the main reasons for creating substrates for reentry, which is responsible for recurrence and maintenance of AF. Mice treated with GLP-1 receptor agonists had a reduction in atrial fibrosis, by having a direct impact on fibroblast activation and profibrotic signaling. Essentially, these molecules have an antifibrotic effect on atria. We decided to investigate this further in clinical data.”
For the retrospective study, the researchers used the TriNetX research network to identify adults with type 2 diabetes who underwent AF ablation from 2015 to Dec. 1, 2022. Using propensity matching, the researchers compared 2,894 patients taking a GLP-1 receptor agonist at baseline with 2,894 patients not taking one at baseline.
At 12 months, the GLP-1 group had reduced risk for the primary composite outcome of postprocedure cardioversion, new antiarrhythmic drug therapy or redo AF ablation compared with the non-GLP-1 group (58.7% vs. 67.2%; HR = 0.75; 95% CI, 0.7-0.8; P < .0001), Sheth and colleagues found.
The GLP-1 group also had lower risk at 12 months for AF readmissions (22.7% vs. 25%; HR = 0.87; 95% CI, 0.78-0.97; P < .0001), HF readmissions (8.7% vs. 11.5%; HR = 0.73; 95% CI, 0.62-0.86; P = .004) and all-cause mortality (2.5% vs. 3.9%; HR = 0.63; 95% CI, 0.47-0.84; P = .001), according to the researchers.
There was no difference between the groups in ischemic stroke readmissions at 12 months.
“We did expect some degree of positive findings, but the extent to which these findings were positive in our study was a little bit surprising,” Sheth told Healio. “The impact of GLP-1 receptor agonists on reduction of atrial fibrosis is one of the main reasons, but also, these molecules have been associated with reduction in body weight and HbA1c. Improving body weight and diabetes control has been associated with improvement in AF recurrence. It’s a combination of all three of these factors.”
Since the study was retrospective, it is not enough to change practice, so large randomized clinical trials addressing this question are needed, Sheth said.
“Studies like these are hypothesis-generating and serve as a nidus for larger randomized trials to take place,” he said.
“These molecules can help patients with a wide variety of conditions,” Sheth told Healio. “But we all need to work together to improve the accessibility of these drugs to our patients. That means reducing the cost of these medications.”
For more information:
Aakash R. Sheth, MD, can be reached at shethar@upmc.edu; X (Twitter): @aakashrsheth.
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Sheth AR, et al. Abstract CE-482907-002. Presented at: Heart Rhythm 2024; May 16-19, 2024; Boston.
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