Weight Loss Surgery Before Atrial Fibrillation Ablation Significantly Reduces Rate of Recurrence

A new study shows that overweight patients who have bariatric surgery before undergoing ablation reduce their risk of the arrhythmia returning. This is the first study to look at the relationship between weight loss surgery and atrial fibrillation (AF) ablation. The results show a three-fold reduction in recurrence rates for patients that had bariatric surgery before ablation. The study was presented today at Heart Rhythm 2019, the Heart Rhythm Society’s 40th Annual Scientific Sessions.
 
Both obesity and AF are increasing in epidemic proportions, and both increase the prevalence of cardiovascular disease events. According to The ARIC (Atherosclerosis Risk In Communities), almost one in five cases of AF can be attributable to obesity. Recently, obesity has emerged as an independent risk factor for AF. For example, long-term prospective data from the Framingham Heart Study with almost 14 years of follow-up has identified obesity as an important modifiable risk factor for AF.¹ While ablation is a common procedure used to treat the arrhythmia, overweight patients are more likely to experience AF recurrence after ablation.²
 
The study included 239 morbidly obese patients who were undergoing AF ablation. The patients had a BMI greater than 40 kg/m². Of these patients, 51 underwent bariatric surgery prior to ablation. Recurrence rates of AF were gathered during a mean follow-up of three years (36.31 months) after ablation.
 
The results showed a marked reduction in AF recurrence rates for patients who underwent preablation bariatric surgery. Of the patients who did not undergo bariatric surgery, 114/188 (60.6 percent) experienced recurrent AF compared to 10/51 (19.6 percent) for patients who received bariatric surgery prior to ablation. Further, only six patients (11.8 percent) in the bariatric surgery group received repeat ablation compared to 77 patients (41 percent) in the non-bariatric surgery patient group.
 
“Our study is incredibly timely because there’s been an increase in bariatric surgeries due to the climbing rate of obesity, so we need to better understand the relationship between weight loss surgery and the effect on cardiovascular health specifically when it comes to treatment options for AF,” said lead author, Eoin Donnellan, M.D., Cleveland Clinic. “The results show that clinicians should consider referring their patients for bariatric surgery prior to undergoing an ablation to significantly lower the rate of recurrence. After seeing more than a three-fold reduction rate, it shows that bariatric surgery should be considered a feasible option to help improve the patient’s quality of life.”
 
To further examine the relationship between bariatric surgery and AF ablation, the authors are launching a prospective study looking at long-term outpatient rhythm monitors to assess AF burden before and after bariatric surgery.
 
The Heart Rhythm Society’s 40th Annual Heart Rhythm Scientific Sessions convenes the finest clinicians, scientists, researchers, and innovators in the field of cardiac pacing and electrophysiology. More than 700 of the world’s most notable experts in cardiac rhythm management serve as faculty for over 250 educational sessions while more than 150 exhibitors showcase innovative products and services. Attendees can anticipate an enhanced experience with advanced learning formats and new opportunities for networking.
 
The Heart Rhythm Society is the international leader in science, education and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education and optimal health care policies and standards. Incorporated in 1979 and based in Washington, D.C., it has a membership of more than 7,000 heart rhythm professionals in more than 72 countries around the world. 

References
¹ Journal of the American College of Cardiology Oct 2017, 70 (16) 2022-2035; DOI: 10.1016/j.jacc.2017.09.002
² J Cardiovasc Electrophysiol. 2018 Feb;29(2):239-245. doi: 10.1111/jce.13388. Epub 2017 Dec 1