Weight Loss Surgery Prior to Atrial Fibrillation Ablation Significantly Reduces Rate of Recurrence

SAN FRANCISCO, May 7, 2019 – 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 is scheduled to be presented on Friday, May 10 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 1 in 5 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 AF¹. While ablation is a common procedure used to treat the arrhythmia, overweight patients are more likely to experience AF recurrence after ablation².

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 pre-ablation 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, MD, 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.

Sessions details:
"Moderated Poster Session: Marked Reduction in Recurrence Rates Following Bariatric Surgery in Morbidly Obese Patients Undergoing Atrial Fibrillation Ablation" [May 10, 2019, 3:15 PM – 4:15 PM PDT, EPicenter Lab 3]

The Heart Rhythm Society's 40th Annual 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. For more information, visit www.hrssessions.org.

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

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