No link between tirzepatide and atrial fibrillation, arrhythmia

Treatment with tirzepatide does not appear to be associated with atrial fibrillation (AF) or atrial arrhythmia in individuals with overweight or obesity, according to a meta-analysis.

Researchers searched multiple online databases for randomized controlled trials (RCTs) wherein the incidence of AF or atrial arrhythmia was investigated among individuals with overweight (BMI ≥25 kg/m²) or obesity (BMI ≥30 kg/m²) who were treated with tirzepatide vs placebo.

Ten RCTs met all the inclusion criteria and were included in the meta-analysis. The total population comprised 6,515 adults (mean age 51 years, 53 percent female), with 4,491 (68.9 percent) in the tirzepatide group and 2,024 (31.1 percent) in the placebo group. Mean BMI range was 30–39 kg/m², and most studies had a follow‐up duration of 40–72 weeks.

Of the participants, 42 percent had diabetes, 36 percent had glycated haemoglobin >7 percent, and 32 percent had a glomerular filtration rate <90 mL/min per 1.73 m². Arrhythmia definitions and detection methods varied between studies, with most using scheduled 12‐lead ECGs at predefined visits for event detection.

Pooled data showed low absolute event rates for AF, atrial arrhythmia, and any arrythmia in both the tirzepatide and placebo groups. The corresponding odds ratios were 2.20 (95 percent credible interval [CrI], 0.81–6.75) for atrial fibrillation, 1.84 (95 percent CrI, 1.04–3.90) for any arrhythmia, and 2.16 (95 percent CrI, 0.90–5.87) for atrial arrhythmia with tirzepatide vs placebo.

Tirzepatide showed no clear association with AF or atrial arrhythmia, although the effect estimates for any arrhythmias suggested higher odds with tirzepatide. Researchers emphasized that these findings should be considered exploratory, given that arrhythmias were not prespecified endpoints in most trials and event counts were low.