AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Dual versus Single Incretin Receptor Agonism After Atrial Fibrillation Ablation: A Propensity-Matched Cohort Study
By Bahar AR, Bahar Y, Hewadmal H et al.
Background: Obesity is a major contributor to atrial fibrillation (AF) recurrence following catheter ablation. Tirzepatide has demonstrated superior weight reduction and cardiometabolic benefits compared with traditional glucagon-like peptide-1 receptor agonists (GLP-1RAs), but its impact on post-ablation outcomes remains uncertain. We compared clinical outcomes among patients treated with tirzepatide versus GLP-1RAs following AF ablation. Methods: We conducted a retrospective cohort study using the TriNetX Global Research Network. Adult patients with AF who underwent catheter ablation and subsequently received either tirzepatide or a GLP-1RA were identified. After 1:1 propensity score matching, 1,661 patients remained in each cohort. The primary outcome was AF recurrence. Secondary outcomes included progression to permanent AF, repeat AF ablation, all-cause mortality, ischemic stroke, heart failure hospitalization, cardioversion, atrioventricular nodal ablation, and amiodarone use. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. Results: Compared with GLP-1RAs, tirzepatide was associated with a significantly lower risk of AF recurrence (35.8% vs 42.4%; RR 0.85, 95% CI 0.78-0.92; p<0.001). Tirzepatide was also associated with lower risks of progression to permanent AF (RR 0.55, 95% CI 0.44-0.70; p<0.001), repeat AF ablation (RR 0.80, 95% CI 0.65-0.98; p=0.028), all-cause mortality (RR 0.30, 95% CI 0.17-0.55; p<0.001), ischemic stroke (RR 0.63, 95% CI 0.43-0.92; p=0.016), heart failure hospitalization (RR 0.55, 95% CI 0.45-0.68; p<0.001), cardioversion (RR 0.65, 95% CI 0.53-0.80; p<0.001), and amiodarone use (RR 0.79, 95% CI 0.68-0.92; p=0.002). Rates of atrioventricular nodal ablation were similar between groups (RR 0.87, 95% CI 0.55-1.37; p=0.554). Conclusions: Among patients undergoing AF ablation, tirzepatide was associated with lower risks of AF recurrence, progression to permanent AF, repeat ablation, and several major cardiovascular outcomes compared with GLP-1RAs. These findings suggest that tirzepatide may provide incremental benefits beyond conventional GLP-1RA therapy in patients undergoing rhythm-control strategies for AF and warrant prospective validation.