Atrial fibrillation (AF) is the most common arrhythmia worldwide. AF is associated with
obesity and the co-morbities of obesity, including hypertension and obstructive sleep apnea
(OSA) which increase left atrial (LA) size and decrease LA function. Semaglutide, a
Glucagon-like peptide receptor 1 agonist, is currently approved by the Food and Drug
Administration for weight loss for individuals with and without diabetes. The effects of
pharmacologic weight loss with Semaglutide on AF are unknown. We plan on conducting a
randomized controlled trial of semaglutide versus placebo in individuals with paroxysmal or
early persistent AF (>10% AF burden on ambulatory monitoring, a previous electrical
cardioversion, or AF lasting ≥ 7 days but < 3 months who have a body mass index ≥ 27.0 kg/m2.
The trial will last for 52 weeks. The primary outcome will be the change in AF burden for 2
weeks, immediately before starting the medication or placebo to two weeks starting at week
50, as determined by an implantable loop recorder or two week ambulatory Additional outcomes
will be change in epicardial adipose tissue as determined by chest/abdomen/pelvis computed
tomography scan at enrollment and at week 52, change in apnea-hypopnea index from baseline
sleep study to week 52 sleep study, change in LA longitudinal strain from baseline
echocardiogram to echocardiogram at 52 weeks, and change on symptom surveys.