Nathan Fields, PharmD, MS, BCCP

Cardiology enthusiast, informatics dabbler, forever dog dad, Tennessee native, and a huge nerd | R549 | 🫀Pharmacist

[Subodh Verma @SubodhVermaMD]

🧵 Is it time for a GLP-1 trial in atrial fibrillation?

Atrial fibrillation (AF) is the most common sustained cardiac rhythm disorder worldwide—and it’s accelerating with obesity, diabetes, and aging.
Yet our treatments still focus almost exclusively on electricity, not biology.

🧠 That may be the problem.

Catheter ablation isolates triggers.
Antiarrhythmics suppress signals.
👉 But neither treats the metabolic substrate driving AF recurrence.

Enter GLP-1 receptor agonists.
We already know GLP-1s:
• Induce durable weight loss
• Reduce inflammation
• Improve cardiometabolic health
• Lower incident AF—independent of diabetes or BMI
But here’s the provocative question:
👉 Can GLP-1s protect ablation success?

In a real-world, propensity-matched cohort of AF patients undergoing ablation:
• Semaglutide users had ~91% freedom from atrial arrhythmias at 12 months
• Controls: ~72%
• Despite similar LA size, HF, CAD, diabetes, and BMI

That’s a ~19% absolute difference.
Let that sink in.
Same ablation.
Same anatomy.
Same risk profile.
👉 Different metabolic therapy. Different rhythm outcome.
This suggests something bigger than weight loss:
• Modulation of atrial remodeling
• Reduction in inflammation and oxidative stress
• Favorable effects on autonomic tone and myocardial energetics
AF may not just be an electrical disease.
It may be a cardiometabolic disease with an electrical phenotype.

If true, rhythm control should no longer be:
❌ Drugs or ablation
But:
✅ Ablation + metabolic therapy
The signal is strong.
The biology is plausible.
The clinical need is massive.

🔥 The real question now:
Why haven’t we launched a randomized GLP-1 trial in AF yet?
#AtrialFibrillation #AFib #GLP1 #Semaglutide #HeartRhythm
#Electrophysiology #CatheterAblation #Cardiometabolic
#ClinicalTrials #MedTwitter #CardioTwitter
Semaglutide as adjunctive therapy to catheter ablation in obesity-related paroxysmal atrial fibrillation https://t.co/HIkhGdTLU5

[Jimmy L. Pruitt III, PharmD, BCPS, BCCCP, BCEMP @PharmD_intheED]

ANNEXA is really done.

[Novi Yanti Sari @slumberbell]

What’s 🆕 on the #ESCGuidelines 2025 on #Myocarditis & #Pericarditis🫀

��First-ever combined ESC guidelines
📍Introduces umbrella term: Inflammatory Myopericardial Syndrome (#IMPS) used until diagnosis is clarified
📍Emphasizes use of multimodality imaging especially #whyCMR
📍Clear recommendation for #endomyocardialbiopsy #EMB
📍Genetic background & inherited CMPs highlighted 🧬

Full link 🔗: https://t.co/FhpNaFmXSg

@escardio #ESCCongress @jozinetm @HFA_President

[European Society of Cardiology Journals @ESC_Journals]

Simultaneous publication during #ESCCongress

Hypokalemia as a trigger for atrial fibrillation: Insights from patients with implanted loop recorders - https://t.co/gpD7tJqnJF

#EHJ

[Novi Yanti Sari @slumberbell]

From the latest 2025 #ESCGuidelines for the management of #CVdisease in pregnancy:

💊Choices of medications use during Pregnancy & during lactation+breastfeeding

Full paper @ehj_ed #EHJ: https://t.co/sPjdY7saWh

@escardio @ESC_Journals #ESCCongress
@CardioOb #CardioObstetrics

[NEJM @NEJM]

Presented at #ESCCongress:

In patients with cardiovascular disease and an implantable cardioverter–defibrillator, increasing potassium levels to the high-normal range reduced the risk of arrhythmia events, hospitalizations, and death. Full POTCAST trial results: https://t.co/NCnp8gaUoB

@escardio

[Dr. Martha Gulati ♥️🫀❤️‍🩹🇨🇦 @DrMarthaGulati]

🚨10 electrifying Hot Line sessions and 40+ pivotal trials debuting at #ESCCongress 2025 in Madrid!

‼️Trials targeting long‑held theories related to beta‑blockers post MI, digoxin for #HFrEF, antiplatelets & anticoagulants, novel treatments for Chagas, HCM, hypertension interventions.

Unmissable practice‑changing data!

Have we ever had so many important studies released at one meeting? Does anyone know the answer to this?
#LBCT #Cardiotwitter #CVPrev

[Gregg Fonarow MD @gcfmd]

HFrEF

ARNI+BB+MRA+SGLT2i

Extend median survival by 7-11 YEARS

Self-pay cash price for all 4 💊

$121 per month

Available today

[Jack Pluenneke @JackPluenneke]

This is an extremely high yield document. Jam packed with practical guidance and considerations. Kudos to authors. @accpcardprn @MikeCardioEPRx @downwithTBrown

[European Society of Cardiology Journals @ESC_Journals]

Among statin-treated patients undergoing PCI, residual inflammation but not cholesterol risk was associated with an increased risk of MACE during follow-up. Read more in #EHJ 👉 https://t.co/zJKmRWhQsB

@RoccoMontone @ehj_ed

[Nathan Fields, PharmD, MS, BCCP @cardionate]

Interesting! Would like to see a prospective trial on this (lots of selection bias possible here). Makes sense from a sympatholytic->reduced ectopy burden standpoint (similar to BB) @accpcardprn #EPeeps

[Nathan Fields, PharmD, MS, BCCP @cardionate]

@Cait_Centra This is so interesting. I had no idea it was so controversial

[Cait E. Kulig 🇺🇦 @Cait_Centra]

https://t.co/25zrRyEXXy

[American College of Cardiology @ACCinTouch]

🗝️ Shared decision making for ICDs should highlight the survival benefit associated w/ them but also discuss possible complications associated w/ the device.

Read more key points on #epICD therapy for primary prevention in #HFrEF: https://t.co/YDlVBSolUi #JACCHF

@JACCJournals

[Nathan Fields, PharmD, MS, BCCP @cardionate]

I am so, so excited for this trial to come out soon. I love me some digoxin in select situations, very interested in this data #Digoxin @accpcardprn

https://t.co/ba8PLFFOkA

[American College of Cardiology @ACCinTouch]

Outpatient loading of sotalol through a pharmacist-led, protocol-driven antiarrhythmic clinic is safe & feasible w/ high adherence rates using personal remote ECG recordings.

Read the journal scan to learn more: https://t.co/9YWRx39PRu #JACCCEP

[Europace Editor-in-Chief @EuropaceEiC]

#Europace 📚
⚡️Ventricular arrhythmias in acute heart failure: a clinical consensus statement of the ACVC, the EHRA, and the HFA of the European Society of Cardiology 🫀

@EHRAPresident @ACVCPresident @HFA_President @escardio

Read the full text 👇
🔗https://t.co/n2QYByYrkQ

[Nathan Fields, PharmD, MS, BCCP @cardionate]

🚮

[Scott Dietrich @PCC_PharmD]

Wow!!

Look at this new Annexa-I data! Those mRS numbers and VTE data do NOT look good to me….

[Nathan Fields, PharmD, MS, BCCP @cardionate]

@Cait_Centra The subgroup analysis in RIVER for <3 months since procedure that favored rivaroxaban has always slightly reassured me. IRL, my small n for early DOACs has been successful in practice with no readmissions for valve thrombosis/SE (mostly apixaban pts with biovalve R + afib)

[Ahmed Bennis MD 🫀 @drbennisahmed]

Cardiopulmonary Resuscitation in Patients With Left Ventricular Assist Devices: A Call to Action

Recognition of LVAD-specific emergency situations,

Knowing basic steps to take (and avoid) in case of an LVAD patient emergency

https://t.co/NF4ah4lLno