Abstract
BACKGROUND: Semaglutide is a GLP-1 agonist that modulates metabolism, induces significant weight loss, and has demonstrated substantial cardiovascular benefits. It significantly reduces the risk of developing atrial fibrillation (AF) in high cardiovascular-risk individuals, irrespective of administration route (oral or subcutaneous), underlying diabetes, or BMI. However, it remains unclear whether semaglutide use is associated with a reduced risk of AF recurrence following transcatheter ablation. AIMS: To assess the efficacy of semaglutide as an adjunct therapy for reducing AF recurrence risk in patients undergoing transcatheter ablation. METHODS: This retrospective study, initiated in May 2020 at a tertiary Italian centre, compared a cohort of patients who began semaglutide therapy within three months before or after AF ablation to a propensity score-matched cohort of patients who underwent ablation but had never received GLP-1 agonists. Freedom from any atrial tachyarrhythmia (ATa) recurrence after a 3-month blanking period (BP) was assessed using implantable cardiac monitors (ICM), ECG-Holter, or smartwatches. RESULTS: A total of 53 patients (73.6% male, mean age 56.4 ± 10.2 years) in the semaglutide group were matched by propensity score to 53 control patients. There were no statistically significant differences in age, sex, BMI, type 2 diabetes (DMT2), heart failure (HF), left atrial (LA) volume/body surface area (BSA), or coronary artery disease (CAD) between the two groups. Semaglutide patients had slightly higher rates of hypertension (74% vs 54%). At 12-month follow-up, semaglutide patients showed greater freedom from atrial arrhythmias than the non-semaglutide group (90.6% vs 71.7%, P = 0.013). CONCLUSION: Semaglutide use is associated with a reduced risk of AF recurrence after catheter ablation in a propensity score-matched cohort, indicating its potential as an adjunctive treatment to reduce AF recurrence following ablation. Further studies are needed to confirm these findings and elucidate the effects of GLP-1 agonists on AF recurrence. [Figure: see text] [Figure: see text]