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Influence of bariatric surgery on indices of cardiac autonomic control.
Auton Neurosci. 2009 Dec 03; 151(2):168-73.AN

Abstract

BACKGROUND

Obesity is associated with reduced heart rate variability (HRV), reflecting detrimental changes in cardiac regulation by the autonomic nervous system (ANS). Weight loss reverses this change and ANS dysfunction is thought to have a role in obesity-related cardiac pathology. Few studies have examined the influence of weight-reduction (bariatric) surgery on cardiac autonomic control. This study therefore sought to assess longitudinal changes in indices of cardiac autonomic control following two types of bariatric procedure, laparascopic gastric banding (LGB) and biliopancreatic diversion (BPD).

METHODS

Eleven morbidly obese subjects aged 47.8 +/- 7.9 years (mean+/-SD) with BMI 48.2 +/- 6.9 kg x m(-2) underwent weight-reduction surgery: five received BPD and six received LGB. Holter ECG was recorded and HRV was quantified together with a QT variability index (QTVI), a complexity index (SampEn), and a fractal (scaling) index (DFAalpha). Repeated measures ANOVA compared the indices for the two groups as a function of time (1, 6 and 12 months follow-up).

RESULTS

BMI was reduced by up to 24% (p=0.008) post-surgery despite patients remaining obese at one-year follow-up. Several indices showed prompt and persistent improvement with progressive weight loss, QTVI being the most sensitive discriminator of recovery time (F(3,216)=16.86; p<0.0005; eta(2)=0.190). Autonomic responsiveness was functionally normal throughout. The bariatric procedures induced similar changes in cardiac autonomic control, despite their differing mechanisms of action.

CONCLUSIONS

This pilot study suggests that the mechanism responsible for improving cardiac regulation following bariatric surgery might be the weight loss itself. Furthermore, post-surgery improvement in QTVI implies that weight loss reduces the risk of ventricular arrhythmic events.

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Authors+Show Affiliations

Alam I
Department of Surgery, Morriston Hospital, Swansea.
Lewis MJ
No affiliation info available
Lewis KE
No affiliation info available
Stephens JW
No affiliation info available
Baxter JN
No affiliation info available

MeSH

AdultArrhythmias, CardiacAutonomic Nervous SystemAutonomic Nervous System DiseasesBariatric SurgeryBody WeightElectrocardiographyFemaleHeartHeart RateHumansMaleMiddle AgedObesityRecovery of FunctionTreatment Outcome

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19720569

Clinical Trial Links

Obstructive Sleep Apnea Destabilizes Myocardial Repolarization Homogeneity

Citation

Alam, I, et al. "Influence of Bariatric Surgery On Indices of Cardiac Autonomic Control." Autonomic Neuroscience : Basic & Clinical, vol. 151, no. 2, 2009, pp. 168-73.
Alam I, Lewis MJ, Lewis KE, et al. Influence of bariatric surgery on indices of cardiac autonomic control. Auton Neurosci. 2009;151(2):168-73.
Alam, I., Lewis, M. J., Lewis, K. E., Stephens, J. W., & Baxter, J. N. (2009). Influence of bariatric surgery on indices of cardiac autonomic control. Autonomic Neuroscience : Basic & Clinical, 151(2), 168-73. https://doi.org/10.1016/j.autneu.2009.08.007
Alam I, et al. Influence of Bariatric Surgery On Indices of Cardiac Autonomic Control. Auton Neurosci. 2009 Dec 3;151(2):168-73. PubMed PMID: 19720569.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Influence of bariatric surgery on indices of cardiac autonomic control. AU - Alam,I, AU - Lewis,M J, AU - Lewis,K E, AU - Stephens,J W, AU - Baxter,J N, Y1 - 2009/08/31/ PY - 2009/04/24/received PY - 2009/07/20/revised PY - 2009/08/12/accepted PY - 2009/9/2/entrez PY - 2009/9/2/pubmed PY - 2010/2/2/medline SP - 168 EP - 73 JF - Autonomic neuroscience : basic & clinical JO - Auton Neurosci VL - 151 IS - 2 N2 - BACKGROUND: Obesity is associated with reduced heart rate variability (HRV), reflecting detrimental changes in cardiac regulation by the autonomic nervous system (ANS). Weight loss reverses this change and ANS dysfunction is thought to have a role in obesity-related cardiac pathology. Few studies have examined the influence of weight-reduction (bariatric) surgery on cardiac autonomic control. This study therefore sought to assess longitudinal changes in indices of cardiac autonomic control following two types of bariatric procedure, laparascopic gastric banding (LGB) and biliopancreatic diversion (BPD). METHODS: Eleven morbidly obese subjects aged 47.8 +/- 7.9 years (mean+/-SD) with BMI 48.2 +/- 6.9 kg x m(-2) underwent weight-reduction surgery: five received BPD and six received LGB. Holter ECG was recorded and HRV was quantified together with a QT variability index (QTVI), a complexity index (SampEn), and a fractal (scaling) index (DFAalpha). Repeated measures ANOVA compared the indices for the two groups as a function of time (1, 6 and 12 months follow-up). RESULTS: BMI was reduced by up to 24% (p=0.008) post-surgery despite patients remaining obese at one-year follow-up. Several indices showed prompt and persistent improvement with progressive weight loss, QTVI being the most sensitive discriminator of recovery time (F(3,216)=16.86; p<0.0005; eta(2)=0.190). Autonomic responsiveness was functionally normal throughout. The bariatric procedures induced similar changes in cardiac autonomic control, despite their differing mechanisms of action. CONCLUSIONS: This pilot study suggests that the mechanism responsible for improving cardiac regulation following bariatric surgery might be the weight loss itself. Furthermore, post-surgery improvement in QTVI implies that weight loss reduces the risk of ventricular arrhythmic events. SN - 1872-7484 UR - https://www.unboundmedicine.com/medline/citation/19720569/Influence_of_bariatric_surgery_on_indices_of_cardiac_autonomic_control_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1566-0702(09)00429-9 DB - PRIME DP - Unbound Medicine ER -