Liraglutide may improve post-ablation outcomes in obese patients with AF

The GLP-1 agonist liraglutide may be a useful additional therapy to a risk factor modification (RFM) programme in obese patients with atrial fibrillation (AF) in terms of reducing AF or atrial flutter after ablation. However, larger studies are needed to further explore the potential benefits of liraglutide in this patient population.

“We know that the success rate of AF ablation is lower in obese patients,” claimed Dr Jeffrey Goldberger (University of Miami, FL, USA) [1]. “Therefore, weight loss and RFM were added as a Class 1 recommendation for obese or overweight patients with AF” [1,2]. The current, phase 4 LEAF study (NCT03856632) compared RFM alone with RFM plus treatment with the GLP-1 agonist liraglutide as therapy before ablation for AF in obese patients [1,3]. “The RFM programme included diabetes, hypertension, and hyperlipidemia control, as well as exercise prescription, dietary interventions, sleep apnoea assessment, and alcohol reduction strategies,” said Dr Goldberger [1].

The participants (n=65) were randomised 1:1 to the 2 treatment options. After 3 months of therapy, 59 participants (mean age of 62 years; 27% women; BMI ≥27 kg/m²) underwent ablation, after which the therapy was continued for another 6 months. Subsequently, all participants received RFM for another 6 months.

“At the time of ablation, there was significant weight loss in both groups, but the difference in weight loss between the study arms was not statistically significant (P=0.09),” noted Dr Goldberger. Similarly, both arms showed a significant reduction in epicardial adipose tissue from baseline to the time of ablation (mean 9.0 mm vs 8.2 mm; P<0.001), but no significant difference was reported between the groups (P=0.23). The 1-year freedom from AF or atrial flutter was higher in the liraglutide arm than in the RFM alone arm (83% vs 57%; P=0.036).

Dr Goldberger mentioned that this was a single-centre study with a small sample size. “Although further follow-up is ongoing and additional analyses are pending, larger studies are needed to confirm these findings,” he decided.

1. 
   
   1. Goldberger JJ, et al. Liraglutide effect on atrial fibrillation (LEAF) study. FS06, AHA Scientific Sessions 2023, 11–13 November, Philadelphia, USA.
   2. Hindricks G, et al. Eur Heart J. 2021;42(5):373–498.
   3. Goldberger JJ, et al. Heart Rhythm 2023;20(7): 1079.

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Posted on 29 January 202429 January 2024