Post Prandial High-Grade Atrioventricular Block After Gastric Sleeve Surgery: a Case Report

Bariatric surgery has been shown to improve long-term cardiovascular outcomes in patients with morbid obesity. However, there is limited data on cardiac arrhythmias occurring after bariatric surgery. We report a case of recurrent syncope due to high-grade atrioventricular block (AVB) after gastric sleeve surgery.

A 32-year-old woman with a background of morbid obesity and diet-controlled type 2 diabetes mellitus, presented with recurrent post-prandial syncope two months after gastric sleeve surgery. Her 12 lead ECG (electrocardiogram) showed sinus rhythm with nonspecific T wave inversion in lead III, and her blood tests including serum electrolytes, thyroid function, and autoimmune screening were all within normal limits. Transthoracic echocardiogram demonstrated a structurally normal heart, however a 24-hour Holter monitor revealed episodes of high-grade AVB, corresponding with post-prandial syncopal episodes. Considering her history of recurrent syncope due to post-prandial high-grade AVB, without any reversible causes, she underwent a dual chamber permanent pacemaker implantation. At 3 months clinic follow-up she had not experienced any recurrence of syncope.

Weight loss after bariatric surgery is associated with improved long-term cardiovascular outcomes. However, available data suggests a relationship between bariatric surgery and cardiac bradyarrhythmias. In our case, we report recurrent episodes of syncope due to high-grade AVB after gastric sleeve surgery, treated by permanent pacemaker implantation. To our knowledge, this complication has not been previously reported, and this case highlights the need for further studies to explore the relationship between bariatric surgery and cardiac arrhythmias and to prevent potential complications.