Metabolic and Bariatric Surgery and Risk of Cardiac Arrhythmias and Mortality in Severe Obesity: A Multicenter Real-World Propensity-Matched Study

BACKGROUND: Obesity is strongly associated with cardiovascular disease and cardiac arrhythmias, particularly atrial fibrillation and flutter (AF/AFL). Metabolic and bariatric surgery (MBS) produces durable weight loss and improves cardiometabolic risk factors, but its association with arrhythmia in large real-world populations remains incompletely characterized. OBJECTIVES: To evaluate the association between MBS and the risk of atrial/ventricular arrhythmias and all-cause mortality in adults with severe obesity. SETTING: Multicenter electronic health record network (TriNetX Global Collaborative Network). METHODS: We conducted a retrospective cohort study of adults with severe obesity using the TriNetX Global Collaborative Network. Patients undergoing MBS were compared with nonsurgical controls without prior arrhythmias. One-to-one propensity score matching was performed based on demographic characteristics and established arrhythmia risk factors. Outcomes included incident AF/AFL, ventricular tachycardia, ventricular fibrillation, cardioversion, and all-cause mortality. Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS: After propensity score matching, 38,953 patients were included in each cohort. AF/AFL occurred less frequently in the MBS cohort compared with non-surgical controls (2.1% vs 3.3%; HR .73, 95% CI .67-.79). Ventricular tachycardia (HR 1.02, 95% CI .83-1.25), ventricular fibrillation (HR 1.53, 95% CI .80-2.92), and cardioversion (HR .92, 95% CI .62-1.23) were not significantly different between groups. All-cause mortality was significantly lower among patients undergoing MBS compared with nonsurgical controls (.5% vs 2.8%; HR .24, 95% CI .20-.28). CONCLUSIONS: In this large real-world cohort, MBS was associated with a lower risk of incident AF/AFL and substantially reduced all-cause mortality compared with non-surgical management.