{
 "checked": "2026-10-27",
 "page": "https://jabbitapp.com/research/glp1-ozempic-wegovy-zepbound-atrial-fibrillation-afib-teardown.html",
 "why_now": "Heart Rhythm network meta-analysis (Barbosa et al.), published online October 26, 2026, doi 10.1016/j.hrthm.2026.10.052, PMID 42933519. Abstract read; full text paywalled; the PubMed record lists no disclosure statement.",
 "abstract_quotes": {
  "42933519": {
   "title": "Glucagon-Like Peptide-1 Receptor Agonists and Risk of Arrhythmias: A Network Meta-Analysis",
   "journal": "Heart Rhythm",
   "quotes": [
    "A total of 94 RCTs involving 155,989 patients were included, comparing 12 GLP-1 RAs and co-agonists.",
    "A comprehensive search of databases was conducted from inception to December 2025.",
    "significantly reducing AF incidence compared with placebo (RR 0.82; 95% CI: 0.68 to 0.99), and compared with tirzepatide (RR 0.57; 95% CI: 0.37 to 0.88)",
    "dulaglutide was associated with an increased risk of AF, while lixisenatide was associated with a decreased risk in atrioventricular blocks",
    "For AF, semaglutide presented a p-score of 0.7885, while tirzepatide and dulaglutide scored 0.1830 and 0.1750, respectively.",
    "Further studies focusing on arrhythmic outcomes are needed to confirm these findings."
   ]
  },
  "42714458": {
   "title": "Tirzepatide and the Incidence of Atrial Fibrillation in Adults With Overweight or Obesity: An Updated Meta-Analysis of Randomized Controlled Trials",
   "journal": "J Am Heart Assoc",
   "quotes": [
    "Our meta-analysis included 10 randomized controlled trials, including 6515 individuals, of whom 4491 (68.9%) were randomized to tirzepatide.",
    "The pooled OR was 2.20 (95% CrI, 0.81-6.75) for atrial fibrillation, 2.16 (95% CrI, 0.90-5.87) for atrial arrhythmia, and 1.84 (95% CrI, 1.04-3.90) for any arrhythmia.",
    "Tirzepatide was not associated with atrial fibrillation or atrial arrhythmia. Although higher odds of overall arrhythmias were observed, event rates were low and the findings should be interpreted cautiously."
   ]
  },
  "41349790": {
   "title": "Effect of GLP-1 receptor agonists and co-agonists on atrial fibrillation risk in overweight or obesity: systematic review and meta-analysis of randomized controlled trials",
   "journal": "Metabolism",
   "quotes": [
    "Twenty-four RCTs encompassing 40,694 participants were included.",
    "(Risk Ratio = 0.82; 95 % confidence interval, 0.70-0.96; P = 0.012; I2 = 0 %)",
    "No significant between-subgroup differences were observed according to agent type (single-, dual-, or triple-receptor agonists)",
    "This cardioprotective benefit may, at least in part, operate independently of the magnitude of weight loss."
   ]
  },
  "41603358": {
   "title": "Non-antiarrhythmic pharmacotherapy in cardio-renal-metabolic disease and incident atrial fibrillation: a trial meta-analysis",
   "journal": "Eur Heart J",
   "quotes": [
    "Two hundred and forty-nine RCTs involving 745 041 patients were included",
    "treatment of obesity with glucagon-like peptide-1 receptor agonists (RR 0.79, 95% CI 0.63-0.99)",
    "However, the number of AF events per trial was low and none were adequately powered for incident AF."
   ]
  },
  "42668799": {
   "title": "Glucagon-Like Peptide-1 Receptor Agonists, Semaglutide, and Atrial Fibrillation: An Umbrella Review With Methodological Appraisal of Overlapping Meta-Analyses",
   "journal": "Cureus",
   "quotes": [
    "Ten meta-analyses were included",
    "AMSTAR 2 ratings indicated low confidence in five reviews and critically low confidence in four; none achieved moderate or high confidence.",
    "GLP-1 RAs/semaglutide are plausibly associated with lower AF burden, but certainty is low (incident AF) to very low (recurrence).",
    "Adequately powered randomized trials with adjudicated, systematically monitored AF endpoints are required."
   ]
  },
  "39058274": {
   "title": "Glucagon-like peptide-1 receptor agonist semaglutide reduces atrial fibrillation incidence: A systematic review and meta-analysis",
   "journal": "Eur J Clin Invest",
   "quotes": [
    "Ten RCTs were included in the analysis.",
    "Semaglutide reduces the risk of AF by 42% (RR .58, 95% CI .40-.85)"
   ]
  },
  "36034440": {
   "title": "Effects of GLP-1 receptor agonists on arrhythmias and its subtypes in patients with type 2 diabetes: A systematic review and meta-analysis",
   "journal": "Front Endocrinol (Lausanne)",
   "quotes": [
    "A total of 60,081 randomized participants were included",
    "atrial fibrillation [RR=0.96, 95% CI (0.86, 1.07), p =0.43]",
    "8 GLP-1RA cardiovascular outcomes trials"
   ]
  },
  "35699112": {
   "title": "Meta-analysis of cardiovascular outcome trials assessing the impact of glucagon-like peptide-1 receptor agonists on major cardiac arrhythmias",
   "journal": "Acta Cardiol",
   "quotes": [
    "Treatment with GLP-1RAs did not provide significant benefit in the risk for atrial fibrillation (RR = 0.81, 95%CI; 0.78-1.15, I2 = 51%)"
   ]
  },
  "42455922": {
   "title": "Network and Pairwise Meta-Analysis of the Association Between Novel Hypoglycemic Agents and Atrial Fibrillation Risk in Patients With Type 2 Diabetes Mellitus",
   "journal": "Diabetes Metab Res Rev",
   "quotes": [
    "4 RCTs and 21 cohort studies involving 2,171,267 patients were included.",
    "SGLT-2i significantly reduced the risk of AF and new-onset AF"
   ]
  },
  "39217565": {
   "title": "Atrial Fibrillation and Semaglutide Effects in Obesity-Related Heart Failure With Preserved Ejection Fraction: STEP-HFpEF Program",
   "journal": "J Am Coll Cardiol",
   "quotes": [
    "Of the 1,145 participants, 518 (45%) had a history of AF",
    "Semaglutide led to larger improvements in KCCQ-CSS (11.5 points [95% CI: 8.3-14.8] vs 4.3 points [95% CI: 1.3-7.2]; P interaction = 0.001)",
    "There were fewer serious adverse events and serious cardiac disorders in participants treated with semaglutide vs placebo irrespective of AF history."
   ]
  },
  "42892471": {
   "title": "GLP-1 receptor agonist therapy and incident atrial fibrillation in non-diabetic adults with obesity and chronic kidney disease: a propensity matched cohort study",
   "journal": "Int J Cardiol",
   "quotes": [
    "Using the TriNetX US Collaborative Network (66 healthcare organizations), we conducted a retrospective target trial emulation",
    "GLP-1RA use was associated with significantly lower incident AF (1.63% vs. 2.62%; HR 0.655, 95% CI 0.508-0.844; p = 0.001)",
    "support prioritizing this phenotype for dedicated randomized trials"
   ]
  },
  "42033283": {
   "title": "Effect of GLP-1 Receptor Agonists on Post-Ablation Atrial Fibrillation Recurrence: A Meta‑Analysis",
   "journal": "Pacing Clin Electrophysiol",
   "quotes": [
    "Six studies met the inclusion criteria",
    "A random-effects meta-analysis of five studies confirmed this benefit (HR 0.78, 95% CI: 0.61-0.99; I2 = 75%).",
    "GLP-1 RA therapy was associated with reduced AF recurrence after ablation, but methodological limitations warrant cautious interpretation."
   ]
  },
  "25792361": {
   "title": "Long-Term Effect of Goal-Directed Weight Management in an Atrial Fibrillation Cohort: A Long-Term Follow-Up Study (LEGACY)",
   "journal": "J Am Coll Cardiol",
   "quotes": [
    "Of 1,415 consecutive patients with AF, 825 had a body mass index ≥ 27 kg/m(2) and were offered weight management.",
    "Weight loss ≥ 10% resulted in a 6-fold (95% confidence interval: 3.4 to 10.3; p < 0.001) greater probability of arrhythmia-free survival compared with the other 2 groups.",
    "Weight fluctuation >5% partially offset this benefit"
   ]
  },
  "42930907": {
   "title": "Cardiometabolic Substrate Modification in Atrial Fibrillation: Obesity and Epicardial Adipose Tissue in the Era of Incretin-Based Therapies and Catheter Ablation",
   "journal": "J Cardiovasc Dev Dis",
   "quotes": [
    "Epicardial adipose tissue (EAT), particularly the peri-left-atrial depot, may provide a local mechanistic bridge",
    "evidence for reduced post-ablation recurrence remains predominantly non-randomized and is susceptible to residual confounding, treatment-selection effects, and healthy-user bias"
   ]
  }
 },
 "conflict_statements": {
  "41349790": "None is related to this manuscript.",
  "39217565": "This trial was funded by Novo Nordisk A/S.",
  "42892471": "All authors had no conflict of interest to declare.",
  "42668799": "no financial relationships"
 },
 "guideline_2023_acc_aha_accp_hrs_af": {
  "pmcid": "PMC11095842",
  "pmid": "38033089",
  "quotes": [
   "Overall lifetime risk is about 30% to 40% in White individuals",
   "AF is associated with a 1.5- to 2-fold increased risk of death",
   "In patients with AF who are overweight or obese (with body mass index [BMI] >27 kg/m2), weight loss is recommended, with an ideal target of at least 10% weight loss to reduce AF symptoms, burden, recurrence, and progression to persistent AF."
  ],
  "weight_loss_recommendation_class": "COR 1, LOE B-R",
  "names_glp1_drugs": false
 },
 "labels": {
  "wegovy_dailymed_setid": "ee06186f-2aa3-4990-a760-757579d8f77b",
  "wegovy_quotes": [
   "5.9 Heart Rate Increase Treatment with WEGOVY was associated with increases in resting heart rate.",
   "Mean increases in resting heart rate of 1 to 4 beats per minute (bpm) were observed in WEGOVY injection-treated adult patients compared to placebo in clinical trials for weight reduction.",
   "More adult patients treated with WEGOVY injection compared with placebo had maximum changes from baseline at any visit of 10 to 19 bpm (41% versus 34%, respectively) and 20 bpm or more (26% versus 16%, respectively).",
   "Instruct patients to inform their healthcare providers of palpitations or feelings of a racing heartbeat while at rest during WEGOVY treatment.",
   "If patients experience a sustained increase in resting heart rate, discontinue WEGOVY."
  ],
  "zepbound_dailymed_setid": "487cd7e7-434c-4925-99fa-aa80b1cc776b",
  "zepbound_quotes": [
   "Heart Rate Increase In a pool of Study 1 and 2, treatment with ZEPBOUND resulted in a mean increase in heart rate of 1 to 3 beats per minute compared to no increase in placebo-treated patients."
  ],
  "note": "Wegovy lists Heart Rate Increase as Warnings and Precautions 5.9; Zepbound's highlights list no heart-rate warning, and its label reports the increase under adverse reactions (checked Oct 27, 2026)."
 },
 "registry": {
  "NCT06184633": {
   "title": "DUTCH Weight Control in Atrial Fibrillation Study",
   "status": "ACTIVE_NOT_RECRUITING",
   "sponsor": "Rijnstate Hospital",
   "enrollment": 280,
   "masking": "TRIPLE",
   "interventions": [
    "Semaglutide 3.2 MG/ML",
    "Placebo"
   ],
   "primary_completion": "2027-04-10",
   "why_stopped": ""
  },
  "NCT06499857": {
   "title": "Semaglutide for Metabolic Intervention and Adipose Loss to Treat Atrial Fibrillation",
   "status": "RECRUITING",
   "sponsor": "University of Chicago",
   "enrollment": 200,
   "masking": "TRIPLE",
   "interventions": [
    "Semaglutide",
    "Placebo"
   ],
   "primary_completion": "2027-12",
   "why_stopped": ""
  },
  "NCT06802081": {
   "title": "TIRzepatide for the Treatment of Obesity in Patients With Atrial Fibrillation",
   "status": "RECRUITING",
   "sponsor": "The Cleveland Clinic",
   "enrollment": 100,
   "masking": "TRIPLE",
   "interventions": [
    "Tirzepatide",
    "Placebo"
   ],
   "primary_completion": "2026-12-31",
   "why_stopped": ""
  },
  "NCT05209165": {
   "title": "Semaglutide to Reduce Atrial Fibrillation Burden",
   "status": "SUSPENDED",
   "sponsor": "San Francisco Veterans Affairs Medical Center",
   "enrollment": 132,
   "masking": "QUADRUPLE",
   "interventions": [
    "Semaglutide",
    "Placebo"
   ],
   "primary_completion": "2027-05",
   "why_stopped": "Company decision"
  },
  "NCT07275697": {
   "title": "Waiting on Atrial Fibrillation Intervention Therapy (WAIT) Study",
   "status": "RECRUITING",
   "sponsor": "Emma Svennberg",
   "enrollment": 200,
   "masking": "SINGLE",
   "interventions": [
    "Semaglutide 2.4 mg",
    "Standard medical treatment"
   ],
   "primary_completion": "2028-12-30",
   "why_stopped": ""
  },
  "NCT07389941": {
   "title": "Semaglutide PrIor to CathEeter Ablation in Patients With Atrial Fibrillation",
   "status": "NOT_YET_RECRUITING",
   "sponsor": "University of Luebeck",
   "enrollment": 240,
   "masking": "SINGLE",
   "interventions": [
    "Semaglutide (SEMA)"
   ],
   "primary_completion": "2029-04",
   "why_stopped": ""
  },
  "NCT07382024": {
   "title": "Tirzepatide to Reduce rEcurrence And Burden After Ablation of Atrial Fibrillation",
   "status": "NOT_YET_RECRUITING",
   "sponsor": "National Taiwan University Hospital",
   "enrollment": 200,
   "masking": "NONE",
   "interventions": [
    "Tirzepatide",
    "Standard Care (in control arm)"
   ],
   "primary_completion": "2027-12-31",
   "why_stopped": ""
  },
  "NCT07630454": {
   "title": "Tirzepatide on Atrial Fibrillation Recurrence After Catheter Ablation in Patients With Obesity and HFpEF",
   "status": "NOT_YET_RECRUITING",
   "sponsor": "Yunlong Wang",
   "enrollment": 602,
   "masking": "SINGLE",
   "interventions": [
    "Tirzepatide",
    "Structured Lifestyle Intervention"
   ],
   "primary_completion": "2029-08-01",
   "why_stopped": ""
  },
  "NCT07715929": {
   "title": "Effect of Tirzepatide on Recurrence of Atrial Fibrillation After Catheter Ablation in Obese Patients",
   "status": "NOT_YET_RECRUITING",
   "sponsor": "Yunlong Wang",
   "enrollment": 710,
   "masking": "SINGLE",
   "interventions": [
    "Tirzepatide",
    "Structured Lifestyle Intervention"
   ],
   "primary_completion": "2029-09-01",
   "why_stopped": ""
  },
  "NCT03856632": {
   "title": "Liraglutide Effect in Atrial Fibrillation",
   "status": "ACTIVE_NOT_RECRUITING",
   "sponsor": "University of Miami",
   "enrollment": 60,
   "masking": "NONE",
   "interventions": [
    "Liraglutide",
    "RFM",
    "Anti Arrhythmics",
    "Afib Catheter Ablation"
   ],
   "primary_completion": "2026-12-31",
   "why_stopped": ""
  },
  "NCT04885634": {
   "title": "Semaglutide for the Reduction of Arrhythmia Burden in Overweight AF Patients",
   "status": "WITHDRAWN",
   "sponsor": "Axel Brandes",
   "enrollment": 0,
   "masking": "QUADRUPLE",
   "interventions": [
    "Semaglutide Injectable Product",
    "Placebo"
   ],
   "primary_completion": "2024-01",
   "why_stopped": "Not received funding."
  }
 },
 "registry_placebo_controlled_active": [
  "NCT06184633",
  "NCT06499857",
  "NCT06802081"
 ],
 "forest_chart": [
  {
   "label": "Semaglutide vs placebo (network meta-analysis, 2026)",
   "estimate": 0.82,
   "low": 0.68,
   "high": 0.99,
   "measure": "RR",
   "pmid": "42933519"
  },
  {
   "label": "Semaglutide vs tirzepatide (network meta-analysis, 2026)",
   "estimate": 0.57,
   "low": 0.37,
   "high": 0.88,
   "measure": "RR",
   "pmid": "42933519"
  },
  {
   "label": "Semaglutide vs placebo (10 trials, 2024)",
   "estimate": 0.58,
   "low": 0.4,
   "high": 0.85,
   "measure": "RR",
   "pmid": "39058274"
  },
  {
   "label": "GLP-1 drugs in obesity vs placebo (24 trials, 2026)",
   "estimate": 0.82,
   "low": 0.7,
   "high": 0.96,
   "measure": "RR",
   "pmid": "41349790"
  },
  {
   "label": "GLP-1 drugs in obesity vs placebo (EHJ, 2026)",
   "estimate": 0.79,
   "low": 0.63,
   "high": 0.99,
   "measure": "RR",
   "pmid": "41603358"
  },
  {
   "label": "GLP-1 heart-outcome trials in diabetes (8 trials, 2022)",
   "estimate": 0.96,
   "low": 0.86,
   "high": 1.07,
   "measure": "RR",
   "pmid": "36034440"
  },
  {
   "label": "Tirzepatide vs placebo (10 trials, 2026)",
   "estimate": 2.2,
   "low": 0.81,
   "high": 6.75,
   "measure": "OR",
   "pmid": "42714458"
  }
 ],
 "analysis": {
  "note": "Jabbit analysis. Several overlapping meta-analyses of the same trials point to fewer AF reports on GLP-1 drugs, especially semaglutide, in people with obesity; diabetes-only heart-outcome trial pools found no clear effect; a 2026 tirzepatide-only meta-analysis found no clear AF signal but a wide interval leaning the other way and more arrhythmias overall. AF was mostly recorded as an adverse event, not a planned outcome; no trial was powered for it; an umbrella review rates certainty low. Semaglutide vs tirzepatide in the network meta-analysis is largely an indirect comparison. Placebo-controlled trials in people who already have AF are registered, with primary completion dates from Dec 2026 to Dec 2027."
 }
}