GLP‑1 Therapy Improves Atrial Fibrillation Outcomes After Catheter Ablation, Miller School Study Finds
University of Miami Miller School of Medicine researchers found liraglutide significantly reduced AFib recurrence in overweight and obese patients, suggesting a new pre‑ablation treatment strategy.
Catheter ablation has become a cornerstone treatment for atrial fibrillation (AFib), yet long‑term success, especially in patients with persistent AFib, remains inconsistent. Even with advances in technology, many patients experience recurrence within a year, highlighting the need for novel strategies.
In the Liraglutide Effects in Atrial Fibrillation (LEAF) Study, researchers at the University of Miami Miller School of Medicine, led by Jeffrey Goldberger, M.D., cardiac electrophysiologist and professor of cardiovascular medicine at the Miller School, found that adding the GLP‑1 receptor agonist liraglutide to a structured risk‑factor modification program significantly improved freedom from AFib or atrial flutter one year after catheter ablation in overweight and obese patients.
Notably, this benefit occurred without greater short‑term weight loss or greater reductions in epicardial fat compared to risk‑factor modification alone, suggesting the therapy may work through more complex biological pathways.
“Our findings were surprising. While we believed this therapy could be beneficial, the observed magnitude of effect on ablation outcome was much greater than we expected,” said Dr. Goldberger, the senior study author, who presented the final results on March 29 at the 2026 American College of Cardiology’s annual Scientific Sessions in New Orleans. The study was published on March 30 in the Journal of the American College of Cardiology: Clinical Electrophysiology. “We acknowledge that this was a small study, so statistical variability could allow for the true effect to be smaller than what we observed. Even then, the magnitude of the effect we observed was so large that this will most likely stand the test of time and represent a meaningful improvement in ablation outcomes for the strategy of adjunctive and risk‑factor modification when applied before the procedure, as done in LEAF. ”
Obesity is a well‑established risk factor for AFib and is associated with poorer outcomes following catheter ablation. One key suspect is epicardial adipose tissue (EAT) located within the sac surrounding the heart that lies in direct contact with atrial muscle. Unlike other fat depots, EAT is biologically active, releasing inflammatory and pro‑fibrotic signals that may alter electrical conduction and promote arrhythmia.
Inside the LEAF Trial: Testing GLP‑1 Therapy Before Ablation
LEAF was a randomized, single‑center clinical trial that enrolled 59 adults with atrial fibrillation and a body mass index of at least 27 kg/m² who elected to undergo their first catheter ablation. About 80% of participants had persistent AFib, a form of the condition that is typically harder to treat successfully.
Participants were randomized to one of two strategies for at least three months before ablation:
• Risk‑factor modification (RFM) alone, a nurse practitioner‑led program emphasizing weight management, physical activity, blood pressure and glucose control, sleep apnea treatment and lifestyle counseling.
• RFM plus liraglutide, a GLP‑1 receptor agonist commonly prescribed for obesity and diabetes.
Cardiac CT scans were used to measure total and left atrial epicardial fat volume and density, while echocardiography tracked changes in cardiac structure. After ablation, patients were followed for one year using long‑term rhythm monitoring and clinical assessments to detect recurrent AFib or atrial flutter.
GLP‑1 Treatment Improved Freedom from AFib Without Added Weight Loss
Both groups experienced modest weight loss and small reductions in epicardial fat before ablation, with no significant differences between treatment arms. However, clinical outcomes diverged sharply.
At one year, 81% of patients receiving liraglutide plus risk‑factor modification were free from AFib or atrial flutter, compared with 54% of patients in the risk‑factor modification–only group. Among patients with persistent AFib, freedom from recurrence approached 90% in the liraglutide group. Reported success rates for ablation of persistent AFib are typically 50-60% at one year, making this a truly remarkable finding.
Liraglutide therapy was independently associated with a lower risk of recurrence, even after accounting for weight change and epicardial fat volume. However, changes in epicardial fat density, which may reflect alterations in adipose tissue biology rather than size alone, was linked to improved outcomes.
“These findings suggest we may be modifying the biological environment of the atrium in ways we can’t fully capture just by measuring weight or fat volume,” Dr. Goldberger said.
What the Findings Could Change for Patients with Obesity and AFib
The results provide a paradigm shift in how clinicians might approach treatment of patients with Afib, particularly those with obesity and persistent AFib, for catheter ablation.
The current paradigm to address non-pulmonary vein sources of AFib is to extend the ablation to include more atrial tissue, which has had limited success. The LEAF findings suggest that pre‑ablation “substrate stabilization” using targeted medical therapy may improve long‑term success better than empirically targeting AFib with additional ablation lesions.
“This is about setting the stage before the procedure,” Dr. Goldberger said. “If we can make the atrium a less favorable environment for AFib, ablation has a better chance to work.”
Next Steps: Larger Trials and Broader Applications of GLP‑1 Therapy
While LEAF was a relatively small, single‑center study, the magnitude of benefit observed has generated interest in larger trials to confirm the findings and determine optimal timing and duration of GLP‑1 therapy. Ongoing research is also exploring whether similar effects extend to newer agents in this drug class and to broader AFib populations.
“For patients with atrial fibrillation and obesity, this work opens the door to a new treatment paradigm,” Dr. Goldberger said. “Instead of escalating procedural complexity, we may be able to improve outcomes by targeting the biology of the disease itself.”
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Tags: AFib, arrhythmia, atrial fibrillation, cardiovascular, Cardiovascular Division, Dr. Jeffrey Goldberger, heart care, heart disease, obesity