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

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 CHA 2 DS 2 VASc 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.

Effects of Supervised Exercise Training on Atrial Fibrillation

“…39 Some of the benefit of exercise training may be due to weight loss, as weight loss is associated with improved AF symptoms and burden. 40 These results demonstrate that the increased AF incidence observed in endurance athletes does not extend to the more common population of individ-uals with AF, who are obese, with obstructive sleep apnea hypertension, and metabolic syndrome/diabetes. 7 Given the heterogeneous nature of the exercise interventions and the few studies that evaluated AF recurrence and burden, additional larger RCTs with ambulatory monitoring are needed to identify the optimal exercise strategy for AF.…”

“…Cohort studies of risk factor modification with an exercise prescription have shown improved arrhythmia-free survival after AF ablation 39. Some of the benefit of exercise training may be due to weight loss, as weight loss is associated with improved AF symptoms and burden 40. These results demonstrate that the increased AF incidence observed in endurance athletes does not extend to the more common population of individuals with AF, who are obese, with obstructive sleep apnea hypertension, and metabolic syndrome/diabetes 7…”

Effect of Prolonged and Substantial Weight Loss on Incident Atrial Fibrillation: A Systematic Review and Meta-Analysis

“…The reason for exclusion of other trials was specified (lack of details, no controls, pre-existing AF, Figure 1 ). Ten studies [ 22 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ] fulfilled the inclusion criteria ( Table 1 shows details of the 10 studies included in this meta-analysis). The protocol of the meta-analysis has been registered (Prospero, CRD42022374548).…”

“… ( A ) Forest plot of pooled hazard ratios of atrial fibrillation [ 22 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]; ( B ) funnel plots with 95% CI; ( C ) meta-regression analysis of effect as a function of age of BS patients (a) and of the whole cohorts (b). OR = Odds Ratio; 95% CI = confidence interval; SE, standard error.…”

Obesity and Atrial Fibrillation – Bariatric Surgery as a Method of Af Risk Decrease

“…Newer methods include gastric plication, single anastomosis duodeno-ileal bypass -SADI and ileal interposition. Endoscopic methods of obesity treatments are gastric balloon (due to the lack of maintenance of safety devices and the repair of end devices of this method, which ensure the performance of operations that are performed, or that are of high-quality BMI, as well as recorded operational inspections) [15][16][17][18] Bariatric surgery reduces obesity-related disorders that indirectly affect the development of AF. In patients undergoing bariatric surgery, the risk of either HF or AF was reduced by ∼29%.…”