Association between pre-ablation bariatric surgery and atrial fibrillation recurrence in morbidly obese patients undergoing atrial fibrillation ablation

Abstract

Aims Obesity decreases arrhythmia-free survival after atrial fibrillation (AF) ablation by mechanisms that are not fully understood. We investigated the impact of pre-ablation bariatric surgery (BS) on AF recurrence after ablation. Methods and results In this retrospective observational cohort study, 239 consecutive morbidly obese patients (body mass index ≥40 kg/m2 or ≥35 kg/m2 with obesity-related complications) were followed for a mean of 22 months prior to ablation. Of these patients, 51 had BS prior to ablation, and our primary outcome was whether BS was associated with a lower rate of AF recurrence during follow-up. Adjustment for confounding was performed with multivariable Cox proportional hazard models and propensity-score based analyses. During a mean follow-up of 36 months after ablation, 10/51 patients (20%) in the BS group had recurrent AF compared with 114/188 (61%) in the non-BS group (P < 0.0001). In the BS group, 6 patients (12%) underwent repeat ablation compared with 77 patients (41%) in the non-BS group, (P < 0.0001). On multivariable analysis, the association between BS and lower AF recurrence remained significant. Similarly, after weighting and adjusting for the inverse probability of the propensity score, BS was still associated with a lower hazard of AF recurrence (hazard ratio 0.14, 95% confidence interval 0.05–0.39; P = 0.002). Conclusion Bariatric surgery is associated with a lower AF recurrence after ablation. Morbidly obese patients should be considered for BS prior to AF ablation, though prospective multicentre studies should be performed to confirm our novel finding.

Lifestyle modifications for treatment of atrial fibrillation

“…This raises the possibility that prolonged morbid obesity or long-standing persistent AF (or both) may portend an irreversible substrate—‘too little too late’. However, a recent report of managing morbid obesity and predominantly patients with persistent AF using bariatric surgery has challenged this notion demonstrating significant improvement in maintenance of sinus rhythm after ablation 50…”

Atrial Fibrillation Catheter Ablation Complications in Obese and Diabetic Patients: Insights from the US Nationwide Inpatient Sample 2005-2013.

“…The literature extensively describes that poorly controlled obesity and diabetes lead to increased AF recurrence rates after catheter ablation [13][14][15] . Risk factor modi cation like weight loss with or without bariatric surgery, glycemic control, blood pressure control, and sleep apnea treatment have been shown to increase arrhythmia-free survival rates 33 .…”

“…Diabetes mellitus (DM) also is a risk factor, presumably due to increased left ventricular mass and arterial stiffness 12 . Studies have shown that obesity and diabetes, particularly when poorly managed, are associated with high rates of AF recurrence after ablation [13][14][15] . Others have shown that risk factor modi cation reduces the risk of incident and recurrent AF 16,17 .…”

2021 ISHNE/ HRS/ EHRA/ APHRS collaborative statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals

“…Unfortunately, research has shown that this strategy is anything but simple: virtually, no adults (<1%) are compliant with all recommendations and 42% are compliant with only 0-2 recommendations (Folsom et al, 2011). Although there is ample evidence that weight loss and maintaining an ideal weight are beneficial in reducing AF burden and symptoms, compliance with this recommendation is poor; the reasons include among others, inability to track food intake (Abed et al, 2013, Donnellan et al, 2019.…”