Does bariatric surgery improve cardiac autonomic modulation assessed by heart rate variability? A systematic review

Benjamim, Cicero Jonas R.; Pontes, Yasmim Mota de Moraes; Sousa, Francisco Welington de; Porto, Andrey Alves; Júnior, Carlos Roberto Bueno; Silva, Amanda A. Marcelino da; Cavalcante, Taisy Cinthia Ferro; Garner, David M.; Valenti, Vítor Engrácia

doi:10.1016/j.soard.2021.03.022

Cited by 6 publications

(5 citation statements)

References 85 publications

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“…The specific BS procedure was decided by surgeon considering patients’ clinical characteristics. Other preliminary study conducted by other groups [ 28 , 29 , 30 , 31 ] showed that different types of BS performed were effective in improving heart rate variability, suggesting that the main mechanism responsible of this effect may, plausibly, be linked to the loss of fat mass more then to the different surgical procedure.…”

Section: Discussionmentioning

confidence: 94%

“…To the best of our knowledge, this progressive improvement (LT p < 0.001 for both ANSI and Alpha Index) has been never observed hitherto. Indeed, previous papers showed post-BS increase in parasympathetic activity, not always combined with decrease in insulin resistance [ 28 ], by employing nonetheless invasive techniques [ 7 , 58 , 59 ] or 24-h Holter recordings [ 28 , 60 , 61 ]. The heterogeneity in the methodologies used to analyze HRV, as well as in the HRV parameters considered, may—at least partially—explain the conflicting data regarding the effects of BS on CAR.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have explored the influence of BS on ANS balance [ 28 ]. All of the different types of BS performed (Roux-en-Y gastric bypass, vertical sleeve gastrectomy, biliopancreatic diversion, with or without duodenal switch, and adjustable gastric band) proved to be effective in improving heart rate variability (HRV).…”

Section: Introductionmentioning

confidence: 99%

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Progressive Additive Benefits of Prehabilitation and Subsequent Bariatric Surgery on Cardiac Autonomic Regulation as Assessed by Means of a Simple Unitary Composite Index: Preliminary Data from an Observational Study

Giovanelli

Palombo

Pina

et al. 2022

JPM

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Obesity is associated with an increased risk of several chronic comorbidities, which may also be determined by dysfunctional autonomic nervous system (ANS). The influence of bariatric surgery (BS) on ANS balance was explored in previous studies, but with high heterogeneity in both the assessment timing and methods employed. In the present observational study, we applied a clinical protocol which considers two subsequent phases. Twenty-nine non-diabetic obese subjects were studied at baseline (T0), after one month of lifestyle modification (prehabilitation) (phase 1-T1), and after eight months following BS (phase 2-T2). ANS regulation was assessed across the three study epochs by means of ANSI, a single composite percent-ranked proxy of autonomic balance, being free of gender and age bias, economical and simple to apply in a clinical setting. The aim of the present study was to investigate the effects of the clinical protocol based on prehabilitation and subsequent BS on the ANS regulation by means of ANSI. Potential intertwined correlations with metabolic parameters were also investigated. Notably, we observed a progressive improvement in ANS control, even by employing ANSI. Moreover, the reduction in the markers of sympathetic overactivity was found to significantly correlate with the amelioration in some metabolic parameters (fasting glucose, insulin levels, and waist circumference), as well as in stress and tiredness perception. In conclusion, this study provides convincing evidence that a unitary proxy of cardiac autonomic regulation (CAR) may reflect the progressive improvement in autonomic regulation following behavioral and surgical interventions in obese patients. Intriguingly, this might contribute to reducing cardiovascular and metabolic risk.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

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Progressive Additive Benefits of Prehabilitation and Subsequent Bariatric Surgery on Cardiac Autonomic Regulation as Assessed by Means of a Simple Unitary Composite Index: Preliminary Data from an Observational Study

Giovanelli

Palombo

Pina

et al. 2022

JPM

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“…18 Weight loss after bariatric surgery has been shown to decrease resting HR and affect HR variability. 19 Moreover, several studies showed that patients with obesity have a prolonged QT interval, highlighting the effects of bariatric surgery on reducing QTc. [20][21][22] In our study, resting HR and QTc interval were found signi cantly decreased at six months post SG and further changes are not evident one year after bariatric surgery.…”

Section: Sg and Ecg Parametersmentioning

confidence: 99%

The incidence of cardiac arrhythmias during exercise stress testing: a focus on patients with severe obesity undergoing sleeve gastrectomy

et al. 2023

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Introduction: Obesity is associated with a higher risk of cardiac arrhythmias. Sleeve Gastrectomy (SG) is a common bariatric surgery with bene cial effects on weight loss and comorbidities. The study aimed to investigate the prevalence of arrhythmias during maximal exercise testing in patients with moderatesevere obesity and to evaluate the impact of SG on these arrhythmic events. Methods: All patients with moderate or severe obesity who were considered suitable candidates for SG between June 2015 and September 2020 were recruited. Each patient underwent three incremental, maximal, ECG-monitored cardiopulmonary exercise test one month before and six and twelve months after SG; the frequency and complexity of ventricular premature beats (VPBs) and atrial premature beats (APBs) have been evaluated during rest, exercise and recovery phases.Results: 50 patients with severe obesity (BMI 46.39 ±7.89 kg/m2) were included in the study. After SG, patients presented a decreased BMI (34.15 ± 6.25 kg/m2 at six months post-SG and 31.87 ± 5.99 kg/m2 at twelve months post-SG). At six months post-SG, an increase in VPBs, mainly during the recovery phase, was observed. At twelve months post-SG, a reduction in VPBs compared with the six months evaluation was showed.Conclusion: Although in the early post-surgical phase the risk of exercise-induced arrhythmias may be higher, SG does not seem to increase the occurrence of arrhythmias in the long-term. No life-threating arrhythmias were found during post-SG evaluations.

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“…Lifestyle modifications have been proposed to positively impact HRV in obesity. Moreover, studies have demonstrated that diet‐induced (Poirier, Hernandez, Weil, Shepard, & Eckel, 2001), pharmacologically‐induced (Martin et al, 2011), and surgery‐induced (Benjamim et al, 2021) weight loss improved HRV. Indeed, studies have shown improvement of the autonomic balance (Salamin et al, 2013) and HRV in patients after bariatric surgery (Nault et al, 2007; Pontiroli, Merlotti, Veronelli, & Lombardi, 2013).…”

Section: Introductionmentioning

confidence: 99%

Heart rate variability after bariatric surgery: The add‐on value of exercise

Belzile

Auclair

Roberge

et al. 2022

European Journal of Sport Science

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Purpose: To assess the impact of bariatric surgery and an added supervised exercise training programme on heart rate variability (HRV) in patients with severe obesity. Methods: Fifty-nine patients who underwent bariatric surgery were randomised in the postoperative period to a 12-week supervised exercise training programme (moderate intensity combination aerobic/resistance exercise training programme) or a control group. Indices of HRV including time-domain, spectral-domain, and nonlinear parameters were measured preoperatively, and at 3, 6, and 12 months. Results: After the surgical procedure, both groups improved anthropometric parameters. Type 2 diabetes, hypertension, and dyslipidemia resolutions were similar between groups. Total body weight loss at 6 and 12 months were also comparable between groups (6 months: 28 ± 6 vs. 30 ± 6%; 12 months: 38 ± 9 vs. 38 ± 10%; control vs. intervention group respectively). Bariatric surgery improved HRV parameters at 12 months compared to the pre-operative values in the intervention group: standard deviation of R-R interval (SDNN) (156.0 ± 46.4 vs. 122.6 ± 33.1 ms), low frequency (LF) (6.3 ± 0.8 vs. 5.8 ± 0.7 ms 2 ), and high frequency (HF) (5.1 ± 0.8 vs. 4.7 ± 0.9 ms 2 ) (all p<0.001). For the control patients, similar improvements in SDNN (150.0 ± 39.4 vs. 118.8 ± 20.1 ms), LF (6.1 ± 0.9 vs. 5.7 ± 0.8 ms 2 ), and HF (5.0 ± 0.9 vs. 4.7 ± 0.9 ms 2 ) were obtained (all p<0.001). However, there was no add-on impact of the supervised exercise training programme on HRV after 12 months (p>0.05 for all HRV parameters). Conclusion: Bariatric surgery is associated with an improvement in HRV. A supervised exercise training programme in the post-operative period did not modulate further the benefits of bariatric surgery regarding HRV parameters.

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Does bariatric surgery improve cardiac autonomic modulation assessed by heart rate variability? A systematic review

Cited by 6 publications

References 85 publications

Progressive Additive Benefits of Prehabilitation and Subsequent Bariatric Surgery on Cardiac Autonomic Regulation as Assessed by Means of a Simple Unitary Composite Index: Preliminary Data from an Observational Study

Progressive Additive Benefits of Prehabilitation and Subsequent Bariatric Surgery on Cardiac Autonomic Regulation as Assessed by Means of a Simple Unitary Composite Index: Preliminary Data from an Observational Study

The incidence of cardiac arrhythmias during exercise stress testing: a focus on patients with severe obesity undergoing sleeve gastrectomy

Heart rate variability after bariatric surgery: The add‐on value of exercise

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