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Favorable electrocardiographic changes after substantial weight loss in patients with morbid obesity

Results of a prospective study

Günstige elektrokardiographische Veränderungen nach substanzieller Gewichtsabnahme bei Patienten mit krankhafter Adipositas

Ergebnisse einer prospektiven Studie

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Abstract

Background

Obese patients have an increased risk of arrhythmias and sudden death, even in the absence of structural heart disease and cardiac dysfunction. This study aimed to determine whether weight loss by bariatric surgery has an effect on arrhythmia-related electrocardiographic (ECG) variables in morbidly obese patients.

Methods

In this prospective study, the data of 48 patients were analyzed. All ECG variables that have the potential to predict ventricular arrhythmia were evaluated before surgery, and were compared with the 1‑month and 6‑month follow-up results.

Results

The mean body mass index was 45.74 ± 5.60 kg/m2 before surgery. There was a statistically significant decline in body mass index in the first and sixth month after surgery (39.26 ± 5.00 kg/m2 and 31.71 ± 4.49 kg/m2, respectively; p < 0.001). Furthermore, notable reduction was found in terms of heart rate measurements—QTc‑d, JTc, JTc‑d, Tp‑e, TP-e/QT, TP-e/QTc—in the first month and sixth month compared with baseline (p < 0.001 for all comparisons). Several ECG variables, such as heart rate (r = 0.369, p = 0.001), QTc‑d (r = 0.449, p = 0.001), JTc‑d (r = 0.324, p = 0.002), Tp‑e (r = 0.592, p = 0.001), Tp-e/QTc (r = 0.543, p = 0.001), Tp-e/JTc (r = 0.515, p = 0.001), exhibited a positive and significant correlation with weigh loss. Moreover, a negative and weakly significant correlation was found between the index of cardiac electrophysiological balance (r = −0.239, p = 0.004) and body mass index.

Conclusion

Substantial weight loss following laparoscopic sleeve gastrectomy in obese patients is accompanied by a significant improvement in ventricular repolarization. Therefore, this effect may lead to a decrease in the incidence of lethal ventricular arrhythmia and sudden cardiac death.

Zusammenfassung

Hintergrund

Adipöse Patienten weisen ein erhöhtes Risiko für Arrhythmien und plötzlichen Herztod auf, selbst wenn keine strukturellen Herzerkrankungen und kardialen Funktionsstörungen bestehen. Ziel der vorliegenden Studie war es zu untersuchen, ob eine Gewichtsabnahme mittels bariatrischer Chirurgie einen Effekt auf arrhythmiebedingte elektrokardiographische (EKG-)Parameter bei krankhaft adipösen Patienten hat.

Methoden

In der vorliegenden prospektiven Studie wurden die Daten von 48 Patienten ausgewertet. Alle EKG-Parameter, welche das Potenzial zur Vorhersage ventrikulärer Arrhythmien haben, wurden präoperativ beurteilt und mit den Nachuntersuchungsergebnissen nach einem und 6 Monaten verglichen.

Ergebnisse

Der mittlere Body-Mass-Index betrug präoperativ 45,74 ± 5,60 kg/m2. Es gab eine statistisch signifikante Senkung des Body-Mass-Index im ersten und sechsten Monat nach der Operation (39,26 ± 5,00 kg/m2 bzw. 31,71 ± 4,49 kg/m2; p < 0,001). Darüber hinaus fand sich eine deutliche Senkung in Bezug auf Herzfrequenzmessungen – QTc‑d (korrigierte QT-Dispersion), JTc (korrigiertes JT-Intervall), JTc‑d (korrigierte JT-Dispersion), Tp‑e (T-Wellen-Gipfel bis -Ende), TP-e/QT, TP-e/QTc (korrigiertes QT-Intervall) – im ersten und sechsten Monat nach der Operation im Vergleich zum Ausgangsbefund (p < 0,001 für alle Vergleiche). Verschiedene EKG-Parameter, z. B. Herzfrequenz (r = 0,369; p = 0,001), QTc‑d (r = 0,449; p = 0,001), JTc‑d (r = 0,324; p = 0,002), Tp‑e (r = 0,592; p = 0,001), Tp-e/QTc (r = 0,543; p = 0,001), Tp-e/JTc (r = 0,515; p = 0,001), zeigten eine positive und signifikante Korrelation mit der Gewichtsabnahme. Außerdem wurde eine negative und schwach signifikante Korrelation zwischen iCEB (Index of Cardiac Electrophysiological Balance; r = −0,239; p = 0,004) und Body-Mass-Index festgestellt.

Schlussfolgerung

Eine substanzielle Gewichtsabnahme nach laparoskopischer Schlauchmagenoperation bei adipösen Patienten geht mit einer deutlichen Verbesserung in Bezug auf die ventrikuläre Repolarisation einher. Dieser Effekt führt also möglicherweise zu einer Senkung der Inzidenz letaler ventrikulärer Arrhythmien und des plötzlichen Herztods.

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Abbreviations

BMI:

Body mass index

CAD:

Coronary artery disease

ECG:

Electrocardiography

iCEB:

Index of cardiac electrophysiological balance

JT:

JT interval

JTc‑d:

Corrected JT dispersion

LSG:

Laparoscopic sleeve gastrectomy

QT:

QT interval

QTc:

Corrected QT interval

QTc‑d:

Corrected QT dispersion

SCD:

Sudden cardiac death

Tp‑e:

T wave peak-to-end

VR:

Ventricular repolarization

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Authors and Affiliations

  1. Medical Faculty, Department of Cardiology, Aksaray University, Aksaray, Turkey

    Murat Gul M.D & Sinan Inci M.D

  2. Medical Faculty, Department of General Surgery, Aksaray University, Aksaray, Turkey

    Namik Ozkan M.D

  3. Meram Medical Faculty, Department of Cardiology, Necmettin Erbakan University, Konya, Turkey

    Yakup Alsancak M.D

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Contributions

Murat Gul: conceptualization, data curation, formal analysis, project administration, writing original draft.

Sinan Inci: methodology, data curation, writing original draft, validation.

Yakup Alsancak: investigation, validation, writing review, and editing.

Namik Ozkan: investigation, validation.

Corresponding author

Correspondence to Murat Gul M.D.

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Conflict of interest

M. Gul, S. InciX, N. Ozkan and Y. Alsancak declare that they have no conflict of interests.

Informed consent was collected for all patients, and the study was approved by the local ethics committee (no: 2019 84/1756, date: 01.03.2019). The study was also approved by the Institutional Review Board, and was conducted in accordance with the Helsinki Declaration. All studies mentioned were in accordance with the ethical standards indicated in each case.

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Gul, M., Inci, S., Ozkan, N. et al. Favorable electrocardiographic changes after substantial weight loss in patients with morbid obesity. Herz 46, 567–574 (2021). https://doi.org/10.1007/s00059-020-05019-6

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