AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Comparative Risk of Incident Atrial Fibrillation Following Bariatric Surgery, GLP-1 Receptor Agonists, and Tirzepatide in Patients with Obesity
By Tran E, Partow-Navid R
Background: Obesity is a major modifiable risk factor for atrial fibrillation (AF). While bariatric surgery and incretin-based therapies are effective for weight reduction, their comparative associations with AF risk remain unclear. We sought to compare the incidence of AF among patients with obesity treated with bariatric surgery, glucagon-like peptide-1 receptor agonists (GLP-1RAs), or tirzepatide. Methods: A retrospective cohort study was performed using the TriNetX US Collaborative Network. Adults with obesity (body mass index ≥30 kg/m ² ) without prior AF were identified. Patients were categorized into bariatric surgery, GLP-1RA, and tirzepatide cohorts. Patients with prior AF, prior AF ablation, or prior antiarrhythmic drug exposure were excluded. Propensity score matching (1:1) was performed for pairwise comparisons using age, sex, race, hypertension, diabetes, heart failure, coronary artery disease, sleep apnea, and relevant cardiovascular medications. The primary outcome was incident AF within 3 years. Hazard ratios (HRs) with 95% confidence intervals (CIs) and absolute risk differences (RDs) were calculated. Results: After propensity score matching, 60,525 patients were included in each cohort for the GLP-1RA versus bariatric surgery comparison, 19,759 patients in each cohort for the tirzepatide versus bariatric surgery comparison, and 149,774 patients in each cohort for the tirzepatide versus GLP-1RA comparison. Cohorts were well balanced across baseline characteristics. GLP-1RA therapy was associated with lower incidence of AF compared with bariatric surgery (0.5% vs 0.8%; HR 0.55, 95% CI 0.47-0.63; RD –0.4%; p<0.001). Tirzepatide was associated with lower AF incidence compared with bariatric surgery (0.2% vs 0.6%; HR 0.41, 95% CI 0.30-0.57; RD –0.4%; p<0.001) and compared with GLP-1RA therapy (0.4% vs 0.6%; HR 0.70, 95% CI 0.63-0.77; RD –0.2%; p<0.001). Kaplan-Meier analyses demonstrated significantly greater AF-free survival among patients treated with GLP-1RA therapy and tirzepatide compared with bariatric surgery and among patients treated with tirzepatide compared with GLP-1RA therapy (log-rank p<0.001 for all comparisons). Conclusions: In patients with obesity, incretin-based therapies were associated with lower incidence of atrial fibrillation compared with bariatric surgery, with tirzepatide demonstrating the lowest observed risk. Prospective studies are needed to determine whether these associations reflect differential effects of obesity treatment strategies on atrial remodeling and arrhythmia development and whether incretin-based therapies may represent a strategy for AF prevention in patients with obesity.