Reduced Incidence of QTc Prolongation Following Metabolic and Bariatric Surgery in Female Patients: A Retrospective...

Although metabolic and bariatric surgery (MBS) is an established treatment for obesity, its effects on cardiac electrophysiology remain poorly characterized. This study investigated whether MBS was associated with a reduced risk of QTc interval prolongation in female patients with severe obesity.

This retrospective cohort study utilized the TriNetX database to identify female adults with body mass index ≥ 40 kg/m² who underwent laparoscopic surgery between 2010 and 2023. Patients were stratified into MBS (sleeve gastrectomy or gastric bypass) and control groups (other laparoscopic procedures). We performed 1:1 propensity score matching based on demographics, comorbidities, and laboratory parameters. The primary outcome was the incidence of QTc prolongation (≥ 460 ms) at one-year follow-up. Secondary analyses assessed outcomes at three months and three years to evaluate temporal trends. A prespecified subgroup analysis examined whether the effects differed by surgical technique.

Among 79,796 matched female patients (39,898 per group), MBS was associated with a significantly reduced QTc prolongation cumulative incidence within one year (0.33% vs. 0.77%; Hazard ratio [HR]: 0.41, 95% confidence interval [CI]: 0.33-0.50, p < 0.001). This association remained consistent across follow-up (HRs 0.47 at three months; 0.39 at three years). The association between procedure type and QTc prolongation differed in magnitude, with sleeve gastrectomy showing a lower HR than gastric bypass (0.34 vs. 0.61, p for subgroup difference = 0.005).

MBS confers a sustained three-year reduction in QTc prolongation risk in female patients with severe obesity, likely reflecting the cardiovascular benefits of weight loss and metabolic recovery, though individual contributions cannot be separated.