Join Digital Education Committee member and podcast host Melissa E. Middeldorp, MPH, PhD, along with this week's guest contributors,Sheldon Litwin, MD from the Medical University of South Carolina and Abhishek Deshmuckh, MBBS from the Mayo Clinic for this week's episode.

This real-world retrospective cohort study evaluated whether glucagon-like peptide-1 receptor agonist (GLP-1RA) therapy is associated with improved outcomes after atrial fibrillation (AF) ablation in obese patients using a large multicenter electronic health record database (TriNetX). After propensity matching 6,700 patients (3,350 GLP-1RA users and 3,350 non-users), GLP-1RA therapy was associated with significantly lower AF recurrence, progression to permanent AF, cardiovascular and heart failure hospitalizations, and all-cause mortality over a median ~2-year follow-up, although repeat ablation rates were unchanged. The authors propose that benefits may be mediated through weight-loss, reduction in systemic inflammation and epicardial fat, improved metabolic control, and potential direct atrial effects, but emphasize that causal inference is limited due to observational design and lack of weight-loss trajectory or adherence data. Overall, the study suggests GLP-1RAs could become an adjunct rhythm-control strategy in obese AF patients undergoing ablation, warranting prospective randomized trials.

Learning Objectives

• Understand the association between GLP-1 RA therapy and reduced AF recurrence and cardiovascular outcomes after catheter ablation in obese patients.
• Evaluate the potential mechanisms and clinical implications of GLP-1 RAs as an adjunctive metabolic therapy in rhythm control strategies for AF.

Article for Discussion

Article Authors

Sandrine Venier, Pascal Defaye, Lisa Lochon, Rémi Benali, Arnaud Bisson, Adrien Carabelli, Youssou Diouf, Peggy Jacon, Laurent Fauchier

Podcast Contributors

Melissa E. Middeldorp, MPH, PhD
Abhishek Deshmuckh, MBBS
Sheldon Litwin, MD

Host and Contributor Disclosure(s):

M. Middeldorp

• Honoraria/Teaching/Speaking/Consulting: Axon Therapies, Novo Nordisk, Alleviant, Corvia Medical

Staff Disclosure(s) (note: HRS staff are NOT in control of educational content. Disclosures are provided solely for full transparency to the learner):

S. Sailor: No relevant financial relationships with ineligible companies to disclose.

Join Digital Education Committee member and podcast host Melissa E. Middeldorp, MPH, PhD, along with this week's guest contributors, Joshua Silverstein MD, FHRS from Allegheny Health Network and Jonathan Ariyaratnam, BChir, MA, MB, CCDS, CEPS-A from the University of Adelaidefor this week's episode.

Article for Discussion

Learning Objectives

• Understand how imaging- and ECG-based markers of atrial cardiomyopathy are defined and how they relate to the risk of incident AF, heart failure, and stroke.
• Evaluate how integrating atrial cardiomyopathy markers with clinical and genetic risk scores may improve risk stratification for AF and related cardiovascular outcomes.

Article Authors

Oliver B Vad, Nick van Vreeswijk, Ahmed S Yassin, Yuri Blaauw, Christian Paludan-Müller, Jørgen K Kanters, Claus Graff, Ulrich Schotten, Emelia J Benjamin, Jesper H Svendsen, Michiel Rienstra

Podcast Contributors

Melissa E. Middeldorp, MPH, PhD
Joshua R. Silverstein, MD, FHRS
Jonathan Ariyaratnam, BChir, MA, MB, CCDS, CEPS-A

Host and Contributor Disclosure(s):

M. Middeldorp

• Honoraria/Speaking/Consulting: Medical Device Business Services, Biosense Webster, Inc., Medtronic
• Stocks, Privately Held: Heart Rhythm Clinical Solutions/3PH Alliance

Staff Disclosure(s) (note: HRS staff are NOT in control of educational content. Disclosures are provided solely for full transparency to the learner):

S. Sailor: No relevant financial relationships with ineligible companies to disclose.

Join Digital Education Committee member and podcast host Melissa E. Middeldorp, MPH, PhD, along with this week's guest contributors, Nino Isakadze, MD, MHS, and Geraldine A. Lee, PhD, FESC for this week's episode.

The POP-AF trial was a prospective, randomized controlled study evaluating whether a nurse-led, integrated lifestyle intervention before AF ablation improves outcomes. A total of 145 patients with symptomatic paroxysmal or persistent AF and at least one modifiable risk factor were randomized to either standard pre-ablation care or a structured, multidisciplinary lifestyle program targeting weight loss, physical activity, alcohol reduction, smoking cessation, blood pressure, lipid and glycemic control, and obstructive sleep apnea treatment. After pulsed-field pulmonary vein isolation, patients were followed for 12 months. The primary endpoint, a composite of repeat ablations and cardioversions was reduced by 51% in the intervention group (IRR 0.49, 95% CI 0.30–0.78). Successful index ablation without antiarrhythmic drugs was also significantly higher (76% vs 53%). Notably, these benefits were achieved with an average weight loss (~5.5%), suggesting that comprehensive, personalized risk-factor management meaningfully enhances rhythm control outcomes when implemented before ablation.

Read the Article

Learning Objectives

• Understand how a structured, nurse-led integrated lifestyle intervention before AF ablation significantly reduces repeat procedures and cardioversions compared with standard care.
• Evaluate the role of comprehensive risk-factor modification which includes weight, blood pressure, alcohol use, and OSA management improves rhythm control outcomes in patients undergoing PVI.

Article Authors

Jasper Vermeer, Tineke Vinck-de Greef, Maarten van den Broek, Bianca de Louw, Gijs van Steenbergen, Dennis van Veghel, Lukas Dekker

Podcast Contributors

Melissa E. Middeldorp, MPH, PhD
Nino Isakadze, MD, MHS
Geraldine A. Lee, PhD, FESC

All relevant financial relationships have been mitigated.

Host and Contributor Disclosure(s):

M. Middeldorp

• Research: Apple, Inc., Itamar Medical
• Board Membership: Boston Scientific

• Research: H2020 (EHRA-PATHS)

Staff Disclosure(s) (note: HRS staff are NOT in control of educational content. Disclosures are provided solely for full transparency to the learner):

S. Sailor: No relevant financial relationships with ineligible companies to disclose.