Heart Rhythm 2025: Diabetes Drugs Beneficial for Afib Too

Drugs for weight loss and diabetes not only are good for overall health and glucose management—they’re helpful to the heart as well.

New study data indicate that patients with atrial fibrillation (AF) and obesity treated with a glucagon-like peptide-1 receptor agonist (GLP-1 RA) experienced a reduction in AF-related events, including hospitalization, cardioversion, and ablation for AF.

This multi-center pharmacoepidemiologic study, conducted across 170 U.S. Veterans Affairs hospitals, is among the first to evaluate the clinical effectiveness of GLP-1 RAs for secondary AF prevention in patients with both obesity and pre-existing AF. The TRANSFORM-AF trial findings were presented as a late-breaking clinical trial at Heart Rhythm 2025 in San Diego, Calif.

Despite significant advancements in modern ablation techniques, the residual risk of AF recurrence remains approximately 30% at one year and continues to rise cumulatively over time.ⁱ  This persistent risk is likely driven by inadequately managed cardiometabolic risk factors, with obesity being the most prevalent.ⁱⁱ In the United States, more than 50% of patients undergoing AF ablation are classified as obese, underscoring the need for integrated strategies that target metabolic health alongside procedural interventions.ⁱⁱⁱ

The TRANSFORM-AF study aimed to evaluate whether GLP-1 RAs, typically prescribed for diabetes, could reduce the AF burden in patients with both AF and obesity. This large, robust pharmacoepidemiologic study involving 2,510 patients from U.S. Veterans Affairs medical centers, found that GLP-1 RA use was associated with a 13% reduction in major AF-related events, including hospitalizations for AF, cardioversions, and ablation procedures, during a median three-year follow-up. The GLP-1 RAs’ benefits were even greater for those with severe obesity (BMI over 40). Interestingly, there was only modest weight loss (an additional 4%) with diabetes management doses of GLP-1 RA, indicating a potential non-weight loss mediated effect of GLP-1 RA in AF.

“In patients with atrial fibrillation and obesity, the use of diabetic-dose GLP-1 receptor agonists was associated with improved AF-related outcomes, despite only a modest incremental weight loss,” said Varun Sundaram, M.D., Ph.D., section chief, Advanced Heart Failure, Louis Stokes Cleveland VA Medical Center, University Hospitals Harrington Heart & Vascular Institute, associate professor of Medicine at Case Western Reserve University and TRANSFORM-AF study principal investigator. “Given the growing obesity epidemic and the rising prevalence of atrial fibrillation, the TRANSFORM-AF study lays the foundation for a comprehensive, multimodal metabolic approach in conjunction with novel ablation techniques for patients with AF. Further randomized controlled trials are needed to assess the potential benefits of weight-loss doses of GLP-1 RA in this patient population.”

The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients and is the primary information resource on heart rhythm disorders. Its mission is to improve patient care by promoting research, education, and optimal healthcare policies and standards. Incorporated in 1979 and based in Washington, D.C., it has a membership of more than 9,000 heart rhythm professionals from 94 countries.

The Heart Rhythm Society’s annual Heart Rhythm meeting convenes 9,500 clinicians, scientists, researchers, and innovators in cardiac pacing and electrophysiology. More than 2,000 international experts serve as faculty for the more than 200 educational sessions, forums, symposia, and ceremonies, while over 110 exhibitors showcase innovative products and services.

References
ⁱ Reddy V et al. Pulsed Field or Conventional Thermal Ablation for Paroxysmal Atrial Fibrillation. N Engl J Med 2023;389:1660-1671
ⁱⁱ Sha R, Baines O, Hayes A, Tompkins K, Kalla M, Holmes AP, O’Shea C, Pavlovic D. Impact of obesity on atrial fibrillation pathogenesis and treatment options. Journal of the American Heart Association. 2024; 13(1):e032277.
ⁱⁱⁱ Hsu J et al. Initial Findings From the National Cardiovascular Data Registry of Atrial Fibrillation Ablation Procedures. J Am Coll Cardiol. 2023;81(9):867-878