The incidence of cardiac arrhythmias during exercise stress testing among patients with obesity undergoing sleeve gastrectomy

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Obesity is associated with higher rate of cardiovascular morbidity and mortality, anatomical and functional cardiac alteration.(1) In particular, several studies found an association between increased body weight and arrhythmic events.(2) Sleeve Gastrectomy (SG) is recognized as significant treatment option for obesity, with beneficial effect in both weight loss and comorbidities.(3) Moreover, this treatment results in positively decrease in some basal parameters currently associated with increased risk of arrhythmic events, even if little is known about real incidence of cardiac arrhythmias, especially during exercise, before and after bariatric surgery.(4) Purpose To investigate the prevalence of arrhythmic events during maximal exercise testing in patients with moderate-severe obesity and to evaluate how SG affects the number of arrhythmic events. Methods All patients with moderate or severe obesity who were considered suitable candidates for SG after multidisciplinary evaluations were consecutively included in this study. Each patient underwent an incremental, maximal, ECG-monitored cardiopulmonary exercise testing (CPET) before and 6-months after SG. Presence and complexity of atrial premature beats (APBs) and ventricular premature beats (VPBs) has been evaluated at rest, during exercise and during recovery phase. Results 318 patients with morbidly obesity (BMI 44.20±6.79 kg/m2, age 48.9±10.7 years) were included in the study. After SG, patients presented lower heart rate at rest (80.75±12.60 versus 64.84±9.89 bpm, p<0.001) and an increased exercise time (831.30±195.32 versus 941.13±222.16 s, p<0.001). The analysis of the arrhythmic events during the complete test showed a slight significant difference between pre-SG and post-SG, only regarding number of patients presenting APBs (p=0.038). However, the incidence of arrhythmic events was significantly increased during the recovery phase in post-SG evaluation, both by number of patients with at least one arrhythmic episode and by number of arrhythmic events per minute (Table I). Patients affected by severe obesity had a higher risk occurrence of arrhythmias during CPET, notably atrial premature beats (p=0.038), when compared to patients with moderate obesity. No differences were found among post-SG patients. Men presented more frequently VPBs compared to women, both in pre-SG (p=0.048) and post-SG evaluation (p<0.001). No gender differences were observed in APBs (Figure 1). Conclusion Patients affected by severe obesity show an increased prevalence of atrial premature beats, even if no episode of exercise-induce atrial fibrillation has been described. In the early post-surgical phase, the risk of exercise-induced arrhythmias may be higher during the recovery phase, although SG does not seem to increase the occurrence of life-threating arrhythmias.