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Bariatric Surgery

The incidence of cardiac arrhythmias during exercise stress testing: a focus on patients with severe obesity undergoing sleeve gastrectomy



Obesity is associated with a higher risk of cardiac arrhythmias. Sleeve gastrectomy (SG) is a common bariatric surgery with beneficial effects on weight loss and comorbidities. The study aimed to investigate the prevalence of arrhythmias during maximal exercise testing in patients with moderate-severe obesity and to evaluate the impact of SG on these arrhythmic events.


All patients with moderate or severe obesity who were considered suitable candidates for SG between June 2015 and September 2020 were recruited. Each patient underwent three incremental, maximal, ECG-monitored cardiopulmonary exercise test 1 month before and 6 and 12 months after SG; the frequency and complexity of ventricular premature beats (VPBs) and atrial premature beats (APBs) have been evaluated during rest, exercise and recovery phases.


Fifty patients with severe obesity (BMI 46.39 ± 7.89 kg/m2) were included in the study. After SG, patients presented a decreased BMI (34.15 ± 6.25 kg/m2 at 6 months post-SG and 31.87 ± 5.99 kg/m2 at 12 months post-SG). At 6 months post-SG, an increase in VPBs, mainly during the recovery phase, was observed. At 12 months post-SG, a reduction in VPBs compared with the 6 months evaluation was showed.


Although in the early post-surgical phase the risk of exercise-induced arrhythmias may be higher, SG does not seem to increase the occurrence of arrhythmias in the long-term. No life-threating arrhythmias were found during post-SG evaluations.

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Fig. 1: Arrhythmic events during maximal exercise testing in patients who received functional evaluations 1 month before, 6 and 12 months after sleeve gastrectomy (SG).

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.


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The authors thank Alessandra Fecchio, MD, and the staff of the Sports and Exercise Medicine Division of the Department of Medicine for the valuable support during patients’ evaluations. This research project is part of the Italian initiative of Exercise is Medicine.

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All authors participated in the preparation of the manuscript and approved this submission. Conceptualization: MV and AG. Data curation: MV, DN, GQ and SB. Formal analysis: MV, GQ and FB. Investigation: MV, DN, AG and AE. Methodology: MV, FB and LB. Project administration: RV, LB and AE. Supervision: RV and AE. Writing—original draft: MV. Writing—review and editing: MV, DN, GQ, SB, LB and AE.

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Correspondence to Daniel Neunhaeuserer.

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Vecchiato, M., Quinto, G., Neunhaeuserer, D. et al. The incidence of cardiac arrhythmias during exercise stress testing: a focus on patients with severe obesity undergoing sleeve gastrectomy. Int J Obes 47, 175–180 (2023).

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