Asymptomatic Sinus Bradycardia Following Bariatric Surgery Manish G. Malik, MD, Sona M. Franklin, MD, Latrisha A. Whigham, MS, Andres Castellanos, MD, and John M. Fontaine, MD, MBA* Approximately 121,000 bariatric surgical procedures are performed annually, and salutary effects include a reduction in cardiovascular morbidity and mortality, risk factor modification, and improvement in sympathovagal tone. There are anecdotal accounts of unexplained sinus bradycardia (SB) after significant weight loss but no systematic studies have been conducted. The purpose of this study was to determine the frequency of incident SB, its timing, and association with weight loss, clinical characteristics, and predictors. We evaluated various clinical characteristics including resting heart rate, blood pressure, body mass index (BMI), heart rate reserve (HRR), basal metabolic rate, and exercise regimen in 151 consecutive patients who underwent bariatric surgery. Multiple logistic regression analysis was performed to determine predictors of SB. Twenty-five of 137 patients (18%) experienced postoperative SB. Patients with SB had significantly greater reduction in BMI than those without bradycardia (35 – 9.6% and 25.7 – 13%, respectively, p [ 0.002). HRR was significantly greater in patients with SB (116 – 14 beats/min) compared with those without bradycardia (105 – 14 beats/min, p [ 0.007). Multiple logistic regression analysis revealed that the odds of developing SB were 1.96 and 1.91 and associated with the percent decrease in BMI (95% confidence interval 1.3 to 3.0, p [ 0.002) or increase in HRR (95% confidence interval 1.28 to 2.85, p [ 0.002), respectively. In conclusion, SB occurred 14 – 11 months postoperatively and its predictors were the percent reduction in BMI or increase in HRR. Ó 2014 Elsevier Inc. All rights reserved. (Am J Cardiol 2014;113:1049e1053) No systematic studies have been conducted to determine the frequency and cause of sinus bradycardia (SB) after bariatric surgery. Thus, the objective of this investigation was to undertake a pilot study by reviewing records of 151 patients who underwent bariatric surgery at our institution, to determine the frequency of incident SB, its timing, the magnitude of weight loss associated with SB, baseline clinical characteristics, and the clinical predictors. Methods We reviewed data collected prospectively from 151 consecutive patients who underwent bariatric surgery at Hahnemann University Hospital from 2009 to 2010 to determine the frequency of incident SB and clinical variables predictive of postoperative SB. Patient characteristics (age, gender, co-morbidities, and medications), anthropometric measurements (height and weight), body mass index (BMI), basal metabolic rate (BMR), digital heart rate measurements, and heart rate reserve (HRR) were recorded at each quarterly outpatient visit over a follow-up period of 24 months. Fourteen patients were excluded: 6 because of limited data, 6 required surgical revision, and 2 had medication-induced SB. None of the patients had atrial fibrillation. A total of 137 patients were included in this study. Division of Cardiology, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania. Manuscript received October 11, 2013; revised manuscript received and accepted November 23, 2013. See page 1052 for disclosure information. *Corresponding author: Tel: (215) 762-4641; fax: (215) 762-3028. E-mail address: [email protected] (J.M. Fontaine). 0002-9149/14/$ - see front matter Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.amjcard.2013.11.069

There were 120 laparoscopic Roux-en-Y gastric bypass, 13 laparoscopic banding, and 4 open Roux-en-Y procedures (Figure 1). The co-morbidities specifically evaluated were diabetes mellitus, hypertension, dyslipidemia, obstructive sleep apnea, and hypothyroidism. Hypothyroid patients were further evaluated to determine if they were appropriately medically treated by confirming their thyroid function test results and that presurgical SB was not present. SB was defined as a rate of

Asymptomatic sinus bradycardia following bariatric surgery.

Approximately 121,000 bariatric surgical procedures are performed annually, and salutary effects include a reduction in cardiovascular morbidity and m...
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