Liraglutide therapy significantly reduced epicardial adipose tissue from 83±36ml to 75±32ml (p=0.04) and maximal left atrial volume (p=0.01) in obese patients awaiting AF ablation.
Cohort (n=15)
Does liraglutide-assisted weight loss reduce epicardial adipose tissue and improve left atrial remodeling in obese patients with atrial fibrillation awaiting ablation?
Liraglutide-assisted weight loss prior to atrial fibrillation ablation significantly reduces epicardial adipose tissue and left atrial volumes, indicating reverse atrial remodeling.
p-value: p=0.04
Abstract Introduction Epicardial adipose tissue (EpAT) is an important factor in initiation and persistence of atrial fibrillation, with increasing evidence linking this to poorer outcomes from ablation. While pre-ablation weight loss leads to improved freedom from AF, the mechanism remains elusive. Purpose The aim of this study was to determine whether liraglutide-assisted weight loss reduced EpAT and altered left atrial structure and function using dedicated cardiac magnetic resonance imaging (CMR) in obese AF patients (BMI 30-40) awaiting catheter ablation. Methods This prospective analysis included the first 15 participants from GOAL-AF (NCT-05221229). Following baseline CMR, participants received liraglutide in addition to lifestyle intervention, with repeat imaging ≥120 days later. EpAT quantification utilized standard short-axis cine stacks on 1.5T scanner. Continuous contouring from atrioventricular groove to apex during end-systole generated mass values, converted to volume using standard myocardial density (1.055g/ml). Left atrial volumes employed conventional biplane and stack methodologies. Intra-observer variability was assessed through blinded repeat measurements one month apart. Results Participants (age 62±12 years, 67% female, baseline BMI 35.3±3.3kg/m²) achieved significant weight reduction of 7.4kg (2.7-16.5kg) representing 7% (2-15%) from baseline. All participants tolerated liraglutide therapy with median duration of 126 days (2.6mg daily). EpAT reduced from 83±36ml to 75±32ml (p=0.04). Maximal LA volume decreased significantly by both biplane (59±22 to 53±20ml/m², p=0.01) and stack methods (58±22 to 53±20ml/m², p=0.006). Minimal LA volumes showed comparable reductions (biplane: 35±22 to 30±19ml/m², p=0.04; stacks: 39±22 to 34±20ml/m², p=0.007). Left atrial ejection fraction, and left ventricular parameters remained stable throughout. EpAT measurement reliability proved excellent with intra-observer ICC of 0.90 (95%CI 0.82-0.95) and repeatability coefficient of 13ml. Conclusions This study demonstrated a parallel reduction in both epicardial fat and left atrial volumes, consistent with a mechanistic link between adipose tissue regression and reverse atrial remodelling. Measurement of EpAT is reliable and reproducible using standard cardiac MRI imaging sequences. This approach could transform pre-ablation risk stratification and monitoring, making epicardial fat assessment part of routine clinical practice rather than a research tool. EpAT Measurement
Win et al. (Thu,) conducted a cohort in Atrial fibrillation (n=15). Liraglutide vs. Baseline was evaluated on Epicardial adipose tissue (EpAT) volume (p=0.04). Liraglutide therapy significantly reduced epicardial adipose tissue from 83±36ml to 75±32ml (p=0.04) and maximal left atrial volume (p=0.01) in obese patients awaiting AF ablation.