Impact of glucagon-like peptide-1 receptor agonists on the incidence of atrial fibrillation

BACKGROUND Atrial fibrillation (AF) stands as the most prevalent type of arrhythmia, affecting approximately 60 million individuals world-wide. Although antiarrhythmic drugs (AADs) remain the gold standard for AF treatment, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are arising as potential therapeutic alternatives. AIM To evaluate the impact of GLP-1 RAs on the incidence of AF. METHODS Inclusion criteria included systematic reviews (SRs) that based their analyses on clinical trials, observational studies, controlled trials and network meta-analyses. A total of 8 SRs were selected for data extraction, focusing on semaglutide, liraglutide and dulaglutide. Additionally, the effects of GLP-1 RAs on AF incidence were compared with those of sodium-glucose co-transporter 2 (SGLT2) inhibitors. RESULTS Findings indicate that semaglutide, evaluated in the largest patient cohort across the 8 SRs, consistently reduced AF incidence. However, dulaglutide and liraglutide exhibited inconsistent effects. Notably, as opposed to variable outcomes associated with GLP-1 RAs, SGLT2 inhibitors a class of antidiabetic agents with weight-reducing properties exhibit significant cardiovascular benefits, including reductions in both AF and atrial flutter. CONCLUSION GLP-1 RAs emerge as a promising and potential alternative for AADs in reduction of incidence of AF. However, further research is required to fully determine their therapeutic potential and long-term cardiovascular effects.