Waiting on Atrial Fibrillation Intervention Therapy (WAIT) Study

Emma Svennberg

Status and phase: Not yet enrolling; Phase 4

Conditions: Obesity & Overweight; Atrial Fibrillation (AF)

Treatments: Drug: Semaglutide 2.4 mg; Behavioral: Standard medical treatment

Study type: Interventional

Funder types: Other

Identifiers

NCT07275697

WAIT

2025-524182-25-00 (EU Trial (CTIS) Number)

Details and patient eligibility

About

Atrial fibrillation (AF) is the most common heart rhythm disorder and is associated with symptoms, reduced quality of life, heart failure, stroke, and a high risk of recurrence after catheter ablation. Many patients scheduled for their first ablation are overweight or have obesity, which is one of the strongest predictors of AF recurrence. Weight loss and risk-factor management are known to improve the outcome of ablation, but lifestyle changes are often difficult to achieve in routine care.

Semaglutide (Wegovy®) is a GLP-1 receptor agonist approved in the EU for weight management. It has been shown to produce substantial and sustained weight loss and to improve metabolic and cardiovascular risk factors. Whether treatment with semaglutide before AF ablation can improve long-term rhythm outcomes has never been tested in a randomized clinical trial.

The WAIT-AF study is a randomized, open-label trial with blinded endpoint assessment. The study includes adults with AF who are scheduled for their first catheter ablation and have a BMI ≥30 kg/m², or ≥27 kg/m² with at least one additional cardiovascular risk factor (such as hypertension, diabetes and dyslipidemia). A total of 200 participants will be enrolled.

Participants are randomly assigned in a 1:1 ratio to either standard care or semaglutide (plus lifestyle advice) prior to their scheduled ablation. Semaglutide is administered according to the approved EU label with gradual dose escalation. All participants receive an implantable loop recorder (ILR) before ablation to continuously monitor heart rhythm throughout the study.

The primary objective is to determine whether semaglutide improves arrhythmia-free survival 12 months after AF ablation. Recurrence is defined as AF, atrial flutter, or atrial tachycardia lasting ≥30 seconds on continuous ILR monitoring, excluding the standard 3-month blanking period.

Secondary outcomes include weight loss, changes in blood pressure, AF symptoms, quality of life, AF burden, need for repeat ablation, hospitalizations for cardiovascular causes, and changes in metabolic risk factors. The study also evaluates safety and tolerability of semaglutide in this patient population.

The study aims to determine whether targeted weight management with semaglutide before AF ablation can improve long-term rhythm outcomes and overall cardiovascular health. If successful, this strategy may offer a new approach to optimizing treatment and improving the results of catheter ablation for patients with AF and overweight or obesity

Full description

The WAIT trial evaluates whether metabolic optimization with once-weekly semaglutide prior to catheter ablation can improve rhythm outcomes in patients with atrial fibrillation and overweight/obesity. Excess adiposity and related cardiometabolic risk factors are strongly linked to atrial structural remodeling and higher rates of post-ablation arrhythmia recurrence. Although weight reduction is recommended in guidelines, sustained lifestyle-based weight loss is often difficult to achieve. Semaglutide provides an evidence-based pharmacologic strategy for clinically meaningful weight loss and risk-factor improvement, which may enhance the effectiveness of ablation.

This randomized, open-label study allocates participants 1:1 to semaglutide plus standard of care or standard of care alone for at least three months before undergoing their first AF ablation. All participants receive routine clinical management and continuous rhythm monitoring using an implantable loop recorder for 12 months post-ablation, with blinded adjudication of rhythm outcomes. The study integrates real-world clinical practice, using only routine clinical assessments, registry data, and ILR monitoring without introducing additional invasive procedures.

The trial is designed to determine whether targeted periablation metabolic therapy can increase arrhythmia-free survival, reduce AF burden, improve symptoms and quality of life, and favourably impact cardiovascular risk profiles. Results are expected to inform the role of GLP-1 receptor agonist therapy as part of a structured periablation optimization strategy for patients with AF and overweight or obesity.

Enrollment: 200 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

To be included in the trial, subjects must meet all of the following criteria:

1. Provision of written informed consent prior to participation.

2. Age ≥18 years.

3. Scheduled for first-time catheter ablation for atrial fibrillation using a pulmonary vein isolation (PVI) technique.

4. Body Mass Index (BMI) ≥30 kg/m² (obesity) OR

   BMI ≥27 kg/m² (overweight) with one or more of the following comorbidities:

   • prediabetes (defined as HbA1c 39-47 mmol/mol or fasting glucose 5,6-6,9 mmol/L),

   • known diabetes type 2

   • known hypertension (prior diagnosis and/or treatment with antihypertensive medication)

   • new diagnosis of hypertension (according to ESC GL for hypertension: Systolic BP ≥140 mmHg and/or diastolic BP ≥ 90 mmHg based on two readings on two separate visits, OR Ambulatory BP monitoring (24h average) ≥ 130/80 mmHg)

   • dyslipidemia defined as either one of the following

     • Known diagnosis of hyperlipidemia or
     • Treatment with lipid lowering medication

   OR either of the following:

   • LDL > 3.0 mmol/l

   • Total cholesterol > 5 mmol/l

   • Triglycerides > 1.7 mmol/l

   • HDL (< 1 mmol/l if male, < 1.2 mmol/l if female) AND/OR

     • atherosclerotic cardiovascular disease (prior myocardial infarction (MI), stroke, or peripheral arterial disease with claudication and ankle-brachial index <0.85, prior revascularization, or amputation)
     • obstructive sleep apnea.

5. For women of childbearing potential: Inclusion after a highly sensitive negative pregnancy test and agreement to use highly effective contraception during the study period (e.g., hormonal contraception, intrauterine device, or barrier method combined with spermicide).

Exclusion criteria

• Morbid obesity (BMI >40 kg/m²).
• Current use of GLP-1 receptor agonist therapy or dual agonist therapy within 6 months before screening.
• Current use of DPP-IV inhibitors.
• Diabetes type 1
• Known intolerance or contraindication to semaglutide.
• History of pancreatitis or recurrent hypoglycemia.
• Uncontrolled diabetic retinopathy
• Severe renal failure (estimated glomerular filtration rate [eGFR] <15 mL/min/1.73 m² or in dialysis)
• Severe hepatic failure (decompensated liver disease Child-Pugh class C)
• Severe cardiac failure (NYHA class IV)
• Life expectancy <12 months.
• Inability to self-administer the investigational medicinal product.
• Prior catheter ablation procedure for atrial fibrillation.
• Pregnancy, breastfeeding, or planned pregnancy during or within two months after the study period.
• Participation in another interventional clinical trial within the past 30 days.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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200 participants in 2 patient groups

Randomized to Semaglutide

Experimental group

Description:

Participants randomized to the active arm receive once-weekly subcutaneous semaglutide (Wegovy®) initiated at 0.25 mg and uptitrated to a target dose of 2.4 mg as tolerated, according to the approved SmPC. Treatment begins ≥3 months before the planned first catheter ablation for atrial fibrillation. Participants receive structured lifestyle and weight-management advice in accordance with routine clinical practice.

Treatment:

Behavioral: Standard medical treatment

Drug: Semaglutide 2.4 mg

Standard of care

Active Comparator group

Description:

Participants randomized to the standard-of-care arm receive routine clinical management for atrial fibrillation and weight-related comorbidities without GLP-1 receptor agonist therapy. Usual care may include lifestyle counselling, blood pressure and lipid management, treatment of dysglycaemia, and guideline-directed preparation for first-time catheter ablation. No trial-specific medicinal product is administered. Pa

Treatment:

Behavioral: Standard medical treatment