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Bariatric surgery may lower AF recurrence before ablation

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Eoin Donnellan

SAN FRANCISCO — Bariatric surgery should be recommended for morbidly obese patients with atrial fibrillation before ablation to reduce AF recurrence, according to findings presented at the Heart Rhythm Society Annual Scientific Sessions.

Eoin Donnellan, MD, and colleagues sought to determine the effect of pre-ablation bariatric surgery on AF recurrence after ablation.

“We decided to look at bariatric surgery and ablation because there have been a lot of data looking at the impact of weight loss, glycemic control and other lifestyle interventions on regular AF occurrence after ablation,” Donnellan, a cardiology fellow at Cleveland Clinic, told Cardiology Today. “There have been previous studies looking at the impact of bariatric surgery on weight, diabetes, sleep apnea and inflammation, all things that can decrease AF burden and reduce recurrence rates. That was our rationale for undertaking the study.”

Donnellan and colleagues examined data from 239 morbidly obese patients undergoing AF ablation, 51 of whom previously had bariatric surgery (mean age, 63 years; 51% men).

The primary outcome was AF recurrence at 36 months.

The researchers were able to determine that the bariatric surgery group had a lower recurrent AF rate compared with the nonsurgical group (19.6% vs. 60.6%, P < .001).

In the bariatric surgery group, fewer people underwent repeat ablation compared with the nonsurgical group (11.8% vs. 41%, P < .001), Donnellan and colleagues wrote.

Through multivariate analysis, the researchers identified only bariatric surgery as an independent predictor of arrhythmia-free survival (HR = 0.081; 95% CI, 0.037-0.177), which remained significant after adjustment for weight loss percentage.

Bariatric surgery should be recommended for morbidly obese patients with atrial fibrillation before ablation to reduce AF recurrence, according to findings presented at the Heart Rhythm Society Annual Scientific Sessions.

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“Rather than turning them down for ablation based on the very high recurrence rates, it offers an option to these people, and we’ve shown that bariatric surgery essentially reduces recurrence rates to those nonobese patients,” Donnellan told Cardiology Today. “What we saw was a threefold reduction after bariatric surgery.” – by Earl Holland Jr.

Reference:

Donnellan E, et al. Abstract S-BS03-08. Presented at: Heart Rhythm Society Annual Scientific Sessions; May 8-11, 2019; San Francisco.

Disclosure: Donnellan reports no relevant financial disclosures.