Impact of Bariatric Surgery on Atrial Fibrillation Type

Background: Obesity is an independent risk factor for atrial fibrillation (AF) and is associated with a higher AF burden. Recently, weight loss has been found to be associated with a significant reversal in AF type. Bariatric surgery (BS) is associated with reductions in inflammation, left atrial and ventricular remodeling, sleep apnea, blood pressure, and improved glycemic control, all of which may reduce AF burden. In this study, we sought to determine the impact of BS on AF type. Methods: We studied AF type before and after BS in 220 morbidly obese patients (body mass index, ≥40 kg/m2 ). All patients underwent extended outpatient cardiac rhythm monitoring within 12 months of BS and at least 1 year after BS.Results: There was a significant reduction in body mass index following BS from 49.7±9 to 37.2±9 kg/m2 . Weight loss was the greatest in the gastric bypass group with a mean percentage weight loss of 25% compared with 19% in patients who underwent sleeve gastrectomy and 16% following gastric banding (P <0.0001). Significant reductions in CRP (C-reactive protein), NT-proBNP (N-terminal pro-B-type natriuretic peptide), HbA1C (glycated hemoglobin), and systolic blood pressure were observed in all 3 groups. Reversal of AF type occurred in 71% of patients following gastric bypass, 56% of patients who underwent sleeve gastrectomy, and 50% of patients following gastric banding (P =0.004). On Cox proportional hazards analyses, percentage weight loss was significantly associated with AF reversal (P =0.0002).Conclusions: BS is associated with significant reductions in weight, inflammatory markers, blood pressure, and AF type, and the beneficial effects appear to be the greatest in those undergoing gastric bypass surgery. This study further exemplifies the importance of weight loss and risk factor modification in AF management.