Labedi, Mohamed

ABSTRACT Background Obesity is an important risk factor associated with atrial fibrillation (AF). The impact of glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) on recurrent AF among patients undergoing catheter ablation is not well described. Objective This study aimed to evaluate the effect of GLP‐1 RA on the recurrence of AF among obese patients after catheter ablation. Methods Utilizing the TriNetX research network, we identified patients aged over 18 with obesity (BMI ≥ 30) who underwent AF ablation from January 1, 2015, to December 1, 2022, using Current Procedural Terminology codes. Patients were categorized based on their baseline GLP‐1 RA use. Through propensity‐score matching, each cohort comprised 1558 patients. The primary outcome encompassed a composite of cardioversion, initiation of new antiarrhythmic drug (AAD) therapy, or redo AF ablation. Additional outcomes during the 12‐month follow‐up included AF readmission, heart failure readmissions, readmissions due to ischemic stroke, and mortality, with a separate analysis done for patients with BMI > 40. Results GLP‐1 RA use in patients with obesity undergoing AF ablation was linked to a significantly reduced risk of cardioversion, new AAD therapy, and the need for redo AF ablation (hazard ratio [HR] 0.72 [0.65–0.80]; p < 0.001). At 12 months, individuals on GLP‐1 agonists exhibited a lower likelihood of mortality (HR 0.61 [0.40–0.93]; p < 0.001). Although all other secondary outcomes were lower in the GLP‐1 RA group, there was no significant difference in ischemic stroke between the groups. These results were consistent among patients with BMI > 40, although apart from ischemic stroke, there was no difference in mortality between the two groups. Conclusion The utilization of GLP‐1 RA in individuals with obesity is linked to a decreased likelihood of arrhythmia recurrence following AF ablation, leading to a reduced requirement for cardioversion, AAD therapy, or redo AF ablation.

Introduction: Advances in cardiac implanted electronic devices (CIED) have significantly improved outcomes for patients with heart failure. However, there is a bereft of recent real- world data on the relative effectiveness of cardiac resynchronization therapy with pacing and defibrillator (CRT-D) and continuous resynchronization therapy with pacing (CRT-P) in patients with nonischemic cardiomyopathy (NICM). We hypothesized that the addition of defibrillation therapy in patients with NICM would offer no significant benefit. Methods: We searched the National Readmissions Database (NRD) from 2016-2020 to identify hospitalizations with NICM using appropriate ICD-10 diagnosis and procedure codes. The cohort was further divided into groups with NICM and CRT-D implantation and NICM with CRTP implantation. Results and Discussion: Our final cohort included 8,801 hospitalizations with NICM and CRT-D implantation and 3,399 hospitalizations with NICM and CRT-P implantation. Propensity matching was performed using comorbidities through multivariate logistic regression. Two thousand nine hundred seventeen hospitalizations were included in each of the two groups, CRT-D and CRT-P. Analysis of the propensity-matched cohorts at 180 days revealed a trend toward lower heart failure readmission, all-cause readmission, and all-cause mortality rates in the group with CRTP implantation. However, there was no difference noted in the 180-day hazard ratios of HF readmission [1.08 (0.98-1.19); p = 0.1], all-cause readmission [1.04 (0.87-1.12); p = 0.23], and all-cause mortality [0.83 (0.58-1.19); p = 0.32]. Conclusion: It was found that NICM patients with CRT-D have a trend towards higher HF readmissions, all-cause readmission, and all-cause mortality compared to those with CRT-P, but no significant difference was noted in hazard ratios. The findings of our study raise further questions about the need for defibrillator therapy in patients with NICM and merit further studies to better select candidates for each of these therapies.