Association between pre-ablation bariatric surgery and atrial fibrillation recurrence in morbidly obese patients undergoing atrial fibrillation ablation

Europace. 2019 Oct 1;21(10):1476-1483. doi: 10.1093/europace/euz183.


Aims: Obesity decreases arrhythmia-free survival after atrial fibrillation (AF) ablation by mechanisms that are not fully understood. We investigated the impact of pre-ablation bariatric surgery (BS) on AF recurrence after ablation.

Methods and results: In this retrospective observational cohort study, 239 consecutive morbidly obese patients (body mass index ≥40 kg/m2 or ≥35 kg/m2 with obesity-related complications) were followed for a mean of 22 months prior to ablation. Of these patients, 51 had BS prior to ablation, and our primary outcome was whether BS was associated with a lower rate of AF recurrence during follow-up. Adjustment for confounding was performed with multivariable Cox proportional hazard models and propensity-score based analyses. During a mean follow-up of 36 months after ablation, 10/51 patients (20%) in the BS group had recurrent AF compared with 114/188 (61%) in the non-BS group (P < 0.0001). In the BS group, 6 patients (12%) underwent repeat ablation compared with 77 patients (41%) in the non-BS group, (P < 0.0001). On multivariable analysis, the association between BS and lower AF recurrence remained significant. Similarly, after weighting and adjusting for the inverse probability of the propensity score, BS was still associated with a lower hazard of AF recurrence (hazard ratio 0.14, 95% confidence interval 0.05-0.39; P = 0.002).

Conclusion: Bariatric surgery is associated with a lower AF recurrence after ablation. Morbidly obese patients should be considered for BS prior to AF ablation, though prospective multicentre studies should be performed to confirm our novel finding.

Keywords: Ablation; Atrial fibrillation; Bariatric surgery; Obesity.

Publication types

  • Observational Study

MeSH terms

  • Atrial Fibrillation / epidemiology
  • Atrial Fibrillation / etiology*
  • Atrial Fibrillation / surgery
  • Bariatric Surgery / methods*
  • Body Mass Index
  • Catheter Ablation*
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Male
  • Obesity, Morbid / complications*
  • Obesity, Morbid / epidemiology
  • Obesity, Morbid / surgery
  • Prospective Studies
  • Recurrence
  • Risk Factors
  • Survival Rate / trends
  • Treatment Outcome
  • United States / epidemiology