Incident atrial fibrillation in patients undergoing bariatric surgery: a systematic review and meta-analysis

Background: There are controversial data regarding the relationship between bariatric surgery and atrial fibrillation (AF). This meta-analysis was performed to evaluate (i) the incidence and (ii) the risk of AF in patients following bariatric surgery. Aims: To explore the incidence and risk factors of AF in patients after bariatric surgery. Methods: A literature search was conducted utilising MEDLINE, EMBASE and Cochrane Database from inception through March 2019. We included studies that evaluated the (i) incidence and (ii) risk of AF in patients after bariatric surgery. Pooled incidence and odds ratios (OR) with 95% confidence interval (CI) were calculated using random effects meta-analysis. Results: Seven cohort studies consisting of 7681 patients undergoing bariatric surgery were enrolled in this systematic review. The prevalence of AF in patients undergoing bariatric surgery ranged between 0% and 4.6%. Overall, the pooled estimated incidence of AF following bariatric surgery was 5.3% (95% CI: 1.9-13.8) at a median follow-up time of 7.9 years (interquartile range (IQR) 4.1-15.0 years). Compared to controls, the pooled OR of AF among patients undergoing bariatric surgery was 0.42 (95% CI: 0.22-0.83) at a median follow-up time of 7.9 years (IQR 7.2-19.0 years). Egger regression test demonstrated no significant publication bias in our meta-analysis of AF incidence following bariatric surgery. Conclusion: The overall estimated incidence of AF following bariatric surgery was 5.3%. Our study demonstrates a significant beneficial association between bariatric surgery and AF, with a 0.42-fold decreased risk of AF. Future large-scale studies are needed to confirm the potential benefits of bariatric surgery on risk of AF.