Effect of Prolonged and Substantial Weight Loss on Incident Atrial Fibrillation: A Systematic Review and Meta-Analysis
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Background. Overweight and obesity are associated with atrial fibrillation (AF), and bariatric surgery (BS), able to induce sustained and prolonged weight loss, might represent the ideal treatment in the prevention of AF. Previous studies could not definitely establish a role for weight loss and BS in preventing incident AF so far. During the last few years, several studies on the effect of bariatric surgery on cardiovascular diseases have been published, and we performed a systematic review and meta-analysis to evaluate the role of weight loss through BS in the prevention of incident AF in obesity. Methods. This meta-analysis followed the PRISMA guideline. Eligible studies were controlled trials evaluating the appearance of atrial fibrillation in patients undergoing weight loss through BS as compared with patients receiving medical treatment. Quality of studies was assessed according to the Newcastle-Ottawa Quality Assessment Scale, and risk-of-bias was evaluated employing the Egger’s test. All analyses were run by a random-effects model according to Hartung and Knapp and sensitivity analyses were performed. Heterogeneity was assessed through Q and I2 statistics for each comparison, and potential publication bias was formally investigated. Results. Ten studies were included in the meta-analysis, and the overall result was statistically significant [OR = 0.665 (0.475–0.929), p = 0.017], with significant heterogeneity (Q = 48.98, p < 0.001; I2 = 81.6%), but with no publication bias. In sensitivity analyses, the amount of weight loss, percentage of patients with diabetes and value of the Newcastle-Ottawa Quality Assessment Scale, were all associated with significance of effect. Since age was different in one study, a sensitivity analysis was performed by excluding this study; OR was similar [OR = 0.608 (0.454–0.814), p < 0.001]; heterogeneity was reduced but still significant (Q = 35.74, p < 0.001, I2 = 77.6%) and again no publication bias was detected. Conclusions. Bariatric surgery as compared to medical treatment is associated with reduced appearance of incident AF.
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Obesity is causally associated with atrial fibrillation, with preliminary evidence of reduced incident atrial fibrillation from large weight loss.
“Obesity is also causally associated with atrial fibrillation, with preliminary evidence of reduced incident atrial fibrillation from large weight loss (eg, >10% of total body mass).114”
From Definition and diagnostic criteria of clinical obesity (2025) · cites this paper as [114]
The Discussion and Conclusions (pages unavailable in our copy) report that bariatric surgery is associated with reduced incident atrial fibrillation, possibly through sustained weight loss. The Introduction describes an association between obesity and atrial fibrillation, not an established causal link; the Discussion says a causal relationship between weight loss and prevention of atrial fibrillation still needs confirmation. The paper also says more studies are needed to determine how much weight loss is required, so it does not establish the cited >10% threshold. (LLM, conf=0.88)
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- Authors
- Pontiroli, A., Centofanti, L., Le Roux, C., Magnani, S., Tagliabue, E., & Folli, F.
- Affiliations
- University of Milan (IT)
- Diabetes Complications Research Centre, University College Dublin, D04 V1W8 Dublin, Ireland
- Ospedale San Paolo (IT)
- MultiMedica (IT)
- Corresponding author
- Pontiroli, Antonio
- Venue
- Nutrients
- Publisher
- MDPI AG
- Published
- 2023-02-14
- Volume
- 15
- Issue
- 4
- Pages
- 940
- ISSN
- 2072-6643 (ISSN-L)
- PMC
- PMC9964297
- OpenAlex
- W4320729293
- Cited by
- 13
- References
- 52
- Citations by year
- 2026: 1 · 2025: 7 · 2024: 1 · 2023: 4
- FWCI
- 0.69
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Nutrients (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
- Funders
- Ministero della Salute
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
- Keywords
- atrial fibrillation, bariatric surgery, weight loss, obesity, incident atrial fibrillation, atrial fibrillation prevention, diabetes mellitus, overweight
- MeSH terms
- Atrial Fibrillation, Humans, Obesity, Weight Loss, Bariatric Surgery, Overweight
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