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. 2020 May 12;1(2):96-102.
doi: 10.1016/j.hroo.2020.04.004. eCollection 2020 Jun.

Bariatric surgery to aLleviate OCcurrence of Atrial Fibrillation Hospitalization-BLOC-AF

Uma N Srivatsa  1 , Pankaj Malhotra  1 , Xin J Zhang  1 , Neil Beri  1 , Guibo Xing  2 , Ann Brunson  2 , Mohamed Ali  3 , Dali Fan  1 , Nayereh Pezeshkian  1 , Nipavan Chiamvimonvat  1   4 , Richard H White  5
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Bariatric surgery to aLleviate OCcurrence of Atrial Fibrillation Hospitalization-BLOC-AF

Uma N Srivatsa et al. Heart Rhythm O2. .

Abstract

Background: Obesity is associated with a higher incidence of atrial fibrillation (AF). Weight reduction improves outcomes in patients known to have AF.

Objective: The purpose of this study was to compare the incidence of heart failure (HF) or first-time AF hospitalization in obese patients undergoing bariatric surgery (BAS) vs other abdominal surgeries.

Methods: A retrospective cohort study was conducted using linked hospital discharge records from 1994-2014. Obese patients without known AF or atrial flutter (AFL) who had undergone abdominal hernia or laparoscopic cholecystectomy surgery were identified for each case that underwent BAS (2:1). Clinical outcomes were HF, first-time hospitalization for AF, AFL, gastrointestinal bleeding (GIB), and ischemic or hemorrhagic stroke. Outcomes were analyzed using conditional proportional hazard modeling accounting for the competing risk of death, adjusting for demographics and comorbidities.

Results: There were 1581 BAS cases and 3162 controls (48% age <50 years; 60% white; 79% female; mean CHA2DS2VASc score 1.6 ± 1.2) with follow-up of 66 months. Compared to controls, BAS cases had a significantly lower risk of new-onset AF (hazard ratio [HR] 0.71; 95% confidence interval [CI] 0.54-0.93) or HF (HR 0.74; 95% CI 0.60-0.91) but a higher risk of GIB (HR 2.1; 95% CI 1.5-3.0), with no differences in AFL, ischemic stroke, or hemorrhagic stroke. Reduction in AF improved as follow-up increased beyond 60 months.

Conclusion: In patients undergoing BAS, the risk of either HF or AF was reduced by ∼29% but with greater risk of GIB. The findings support the hypothesis that weight loss reduces the long-term risk of HF or incident AF hospitalization.

Keywords: Atrial fibrillation; Bariatric surgery; Heart failure; Obesity.

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Figures

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Graphical abstract
Figure 1
Figure 1
A: Cumulative incidence of atrial fibrillation (AF). B: Cumulative incidence of heart failure. Cases represent patients undergoing bariatric surgery. Controls are patients undergoing other abdominal surgical procedures. Results represent outcomes after adjustment for the competing risk of death.
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