Low Mass Low Beat: The Effect of Bariatric Surgery on Cardiac Rhythm

Abstract

Obesity is a global health problem, associated with significant morbidity and mortality. It is a multifactorial disorder associated with serious complications including diabetes mellitus, dyslipidemia and Cardiovascular Disease (CVD). Its prevalence has been increasing over the last few decades and has become a modern-day epidemic. The management and the treatment of obesity include lifestyle modifications and increased physical activity. Patients with a BMI of greater than 35 kg/m2 with other comorbidities such as type two diabetes are considered eligible for bariatric surgery. There is a plethora of evidence about the effect of bariatric surgery on medical outcomes including reversal of metabolic disease and reduction of negative cardiovascular outcome. Based on the few reported cases in the medical literature, increased cholinergic tone manifesting as bradycardia and delayed chronotropic response on stress test have been reported in post-bariatric surgery patients with significant weight loss. We reported three cases of patients that underwent bariatric surgery and present with brady-arrythmias. While considering other complications of bariatric surgery, it is important to consider cardiac related sequalae such as bradyarrhythmias like sinus bradycardia, atrioventricular block, sick sinus syndrome due to delayed chronotropic response and irreversible atrioventricular defect could be helpful in clinical decision making. We recommend that an EKG and echocardiogram should be a performed as part as of a routine analysis in patients who had a bariatric surgery.