Semaglutide to Reduce Atrial Fibrillation Burden

• Status: Not yet recruiting
• Trial end date: 2028-05-01
• Target enrollment: 0
• Participant gender: All

Summary

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.

• Phase: Phase 4
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: San Francisco Veterans Affairs Medical Center

Criteria

Inclusion Criteria:

Patients ≥ 18 years old with a BMI ≥ 27 kg/m2 who have paroxysmal AF with a ≥ 10% burden on ambulatory monitoring or a previous electrical cardioversion or early persistent AF (≥ 7 days, < 3 months) who are willing to attempt rhythm control.

Exclusion Criteria:

Unable to consent, a personal or family history of medullary thyroid carcinoma, multiple endocrine neoplasia syndrome type 2, history of allergic reaction to Semaglutide or any of its components, currently pregnant or planning to become pregnant or currently breastfeeding, history of acute pancreatitis, history of pancreatic adenocarcinoma, previous or current GLP-1 RA use, previous or current use of alternative pharmacologic weight loss agents (phentermine, dithylpropion, orlistat, phentermine-topiramate, bupropion-naltrexone, gelesis100, or setmelanotide), unable to tolerate anticoagulation, history of bariatric surgery.