Semaglutide in Atrial Arrhythmias: State of the Art and Future Perspectives

Cardiac arrhythmias, particularly atrial fibrillation (AF), represent a major cause of morbidity and mortality worldwide, especially in individuals with type 2 diabetes mellitus (T2D), obesity, and cardiovascular disease. Traditional antiarrhythmic drugs (AADs) remain the cornerstone of rhythm control, but their efficacy is limited and often accompanied by adverse effects. A multidimensional approach that includes upstream therapy—targeting metabolic, structural and inflammatory substrates—has therefore emerged as a critical strategy in arrhythmia prevention and management. Among novel therapeutic agents, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), particularly semaglutide, are gaining attention for their potential antiarrhythmic properties beyond glycaemic control. This review discusses multidimensional arrhythmia management, current indications for semaglutide, and future perspectives on its role as a potential upstream antiarrhythmic therapy.