Bariatric Surgery and New-Onset Atrial Fibrillation Risk

Study Questions:

Does bariatric surgery reduce the risk of atrial fibrillation (AF)?

Methods:

SOS (Swedish Obese Subjects), a prospective nonrandomized study, evaluated the risk of developing AF among obese Swedish individuals (n = 4,021). The entry criteria included age between 37 and 60 years, and body mass index ≥34 and 38 kg/m2 for men and women, respectively. Roughly one-half of the patients underwent bariatric surgery. The decision to pursue surgery was based on patient preference. The other half of the study population was matched for 18 variables and received conventional care.

Results:

Patients in the control arm were older (48.6 vs. 47.2 years). However, patients in the surgical arm were heavier (121 vs. 115 kg), and were more likely to have hypertension, diabetes, and sleep apnea. Surgery resulted in a 25% reduction in weight at year 1, 20% at year 4, and 18% at year 20. The mean weight in the control group remained unchanged. After a median follow-up of 19 years, new AF was diagnosed in 12% in the surgical group versus 17% in the control group (hazard ratio, 0.71; 95% confidence interval, 0.60-0.83; p < 0.001). Younger patients and those with a high diastolic blood pressure seemed to benefit more.

Conclusions:

The authors concluded that weight loss achieved through bariatric surgery was associated with approximately one-third lower risk of new-onset AF among obese individuals.

Perspective:

Obesity may lead to the development of a substrate susceptible to AF in a number of ways, including its contribution to diastolic dysfunction, sleep apnea, inflammation, abnormal metabolic profile, and autonomic dysfunction. Prior studies have shown that weight loss is associated with a lower risk of recurrent AF in patients undergoing catheter ablation or antiarrhythmic treatment. These studies also stressed the importance of sustained weight reduction, as opposed to cycles of weight loss followed by weight gain. Emerging data also seem to suggest that obesity has a biologic basis and that sustained weight loss may not be possible in some patients. The benefits of weight loss via bariatric surgery may not only extend to vascular disease, but also AF and its sequalae, such as thromboembolism and heart failure.

Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Hypertension, Sleep Apnea

Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Bariatric Surgery, Blood Pressure, Body Mass Index, Diabetes Mellitus, Hypertension, Metabolic Syndrome X, Obesity, Primary Prevention, Sleep Apnea Syndromes, Weight Gain, Weight Loss


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