GLP-1s Pose Heart Risks in Patients With HFrEF and Implants

This retrospective analysis from a Canadian health center evaluated whether the use of GLP-1 receptor agonists affected heart rate and device-related measures in 106 patients with HFrEF and implanted cardiac devices (mean age, 66 years; 81% men; mean BMI, 31.4).
Investigators compared outcomes in 53 patients who initiated GLP-1 therapy after device implantation with those in 53 patients who did not use the drugs between January 2023 and June 2024.
The primary outcome was the difference in heart rate between GLP-1 receptor agonist users and nonusers. Secondary outcomes were arrhythmic events, changes in BMI, and laboratory biomarkers.
Patients were followed up for up to 1 year, and device-related outcomes were monitored at four timepoints.

Heart rate was 7 beats per minute higher in GLP-1 receptor agonist users than in nonusers (P < .01), with the mean difference reaching up to 13 beats per minute in the final phase of evaluation.
GLP-1 receptor agonist users vs nonusers had a more nonsustained ventricular tachycardia events (3372 vs 399; P < .01) and total shocks or antitachycardia pacing therapies (33 vs 3; P = .01).
Investigators observed more events of ventricular tachycardia or fibrillation among GLP-1 receptor agonist users vs nonusers, although the difference was statistically nonsignificant (13 vs 2; P = .07).
GLP-1 receptor agonist use was associated with a 0.45-log units increase in NT-proBNP levels vs nonuse (P = .007). However, GLP-1 receptor agonist users had greater reductions in BMI and A1c levels (P < .05 for both). The number of HF events or all-cause hospitalizations did not differ between the groups.

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