Atrial fibrillation in patients with gastroesophageal reflux disease: A comprehensive review

Roman, Crina; Varannes, Stanislas Bruley des; Mureşan, Lucian; Picoș, Andrei; Dumitraşcu, Dan L.

doi:10.3748/wjg.v20.i28.9592

Cited by 36 publications

(37 citation statements)

References 40 publications

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“…Third, device interrogation confirmed limited suppressions of AF paroxysms by PPI administered to the pacemaker patients with AF and GERD ( Table 5). The first part of this study (Study 1) reconfirmed the association of AF and GERD reported in literature [7][8][9][10] and our recent studies. 14,15 We hypothesized that LA size plays the key role in this association, i.e., an enlarged LA compresses or irritates the lower esophagus, leading to reflux symptoms, because of anatomical proximity.…”

Section: Discussionsupporting

confidence: 87%

“…21 Although controversy exists, 22 the hypothesis of GERD being a risk factor for AF raises the possibility of PPI as adjunctive treatment for AF. 8,9,23 In a part of this study (Study 2), symptoms of both AF and GERD were ameliorated after PPI administration based on disease-specific questionnaires ( Table 2). The therapeutic efficacy of PPI on AF has been sporadically described in a case report and a pilot study.…”

Section: Discussionmentioning

confidence: 82%

See 1 more Smart Citation

Prevalence of gastroesophageal reflux disorder in arrhythmic patients and adjunctive effects of proton pump inhibitors on comorbid atrial fibrillation

Odashiro

Yasuda²,

Yamaguchi

et al. 2015

Int J Basic Clin Pharmacol

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 82%

Prevalence of gastroesophageal reflux disorder in arrhythmic patients and adjunctive effects of proton pump inhibitors on comorbid atrial fibrillation

Odashiro

Yasuda²,

Yamaguchi

et al. 2015

Int J Basic Clin Pharmacol

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“…Causal relationship between AF and GERD is based potentially on the three main factors, such as (a) autonomic nerve activation, (b) mechanical irritation of esophagus to the left atrium (LA) due to anatomical proximity, and (c) esophageal inflammation inducing the development of local pericarditis or atrial myocarditis …”

Section: Gerd As a Cause Of Afmentioning

confidence: 99%

“…The progression of AF is characterized by the electrical and structural remodeling of atria and inflammatory mediators are involved in the development, recurrence, and prognosis of AF . Enlarged LA is characterized by inflammatory cell infiltration and in firm contact with lower esophagus, where LA inflammation may propagate to esophageal adventitia leading to the esophageal mucosal inflammation . The potentially involved mechanisms for natural linkage of AF and GERD are illustrated in Figure .…”

Section: Af As a Cause Of Gerdmentioning

confidence: 99%

Association of atrial fibrillation and gastroesophageal reflux disease: Natural and therapeutic linkage of the two common diseases

Maruyama

Fukata

Akashi

2018

Journal of Arrhythmia

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Atrial fibrillation (AF) is a common arrhythmia and gastroesophageal reflux disease (GERD) is popular in Japan. The two common diseases share several predisposing factors such as lifestyle and senescence, and inflammation and oxidative stress play an important role in their development and progression. Incidental cases of AF treated successfully by proton pump inhibitor (PPI) applied for coexisting GERD have been sporadically reported. An increasing evidence indicates that GERD induces the initiation and the perpetuation of AF. This is caused by the autonomic nerve influence, mechanical compression, and propagation of local inflammation due to proximity of left atrium (LA) and lower esophagus. Meanwhile, AF also develops GERD by mechanical and inflammatory actions of LA characterized by remodeling and inflammation. The robust association of AF with GERD is not limited to their natural interaction, i.e., pharmacological or nonpharmacological treatment of AF is reported to aggravate GERD. Many cardiac drugs (anticoagulants, calcium antagonists, and nitrates) induce esophageal mucosal damage and lower esophageal sphincter relaxation promoting acid reflux. These drugs are frequently prescribed in patients with AF for stroke prevention, rate control, and for coexisting coronary heart disease. Catheter ablation also yields both GERD and esophageal thermal injury, which is a precursor lesion of atrioesophageal fistula. The notion that AF and GERD are mutually interdependent is widely and empirically recognized. However, mechanistic link of the two common diseases and objective evaluation of PPI as an adjunctive AF treatment warrant future large‐scale prospective trials.

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“…There was no statistically significant difference in terms of left atrial area (as a marker of left atrial structural remodeling) in patients with GERD versus those without GERD (25±5. 4 …”

Section: Patients With Gerd Versus Those Without Gerdmentioning

confidence: 99%

Atrial fibrillation and sympathovagal balance in patients with gastroesophageal reflux disease

Floria

Bărboi

Grecu³

et al. 2017

Turk J Gastroenterol

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Atrial fibrillation (AF) is the most common arrhythmia in medical practice. Its incidence has risen in countries with rapidly aging populations (1). Gastroesophageal reflux disease (GERD) is a frequent benign disorder of the upper gastrointestinal tract (2). Owing to the close positioning of the esophagus and the atria and their similar autonomic innervations, it has been proposed that the development of GERD could be associated with the occurrence of AF. Sympathovagal imbalance seems to be a principal mechanism of both AF and GERD (3,4). Hiatus hernia, esophagitis, and a dilated left atrium also seem to be implicated in this association, owing to a potential mechanical effect or inflammatory process. In spite of the fact that the association between GERD and AF is supported by clinical and experimental studies, this relationship is still considered controversial (3). Most studies about the association between AF and GERD are based on retrospective data from national registries or self-reporting questionnaires (3,4)Gastrointestinal Tract Turk J Gastroenterol 2017; 28: 88-93 Atrial fibrillation and sympathovagal balance in patients with gastroesophageal reflux disease ABSTRACTBackground/Aims: Similar autonomic innervation of the esophagus and left atrium with sympathovagal imbalance seems to explain the association between non-valvular atrial fibrillation (AF) and gastroesophageal reflux disease (GERD). We aimed to assess this association via parameters of heart rate variability in time (SDNN) and frequency (low-frequency (LF)/high-frequency (HF) ratio) domains by 24-hour electrocardiographic (ECG) Holter monitoring. Materials and Methods: One hundred thirty-five patients were prospectively included by a joint team consisting of a gastroenterologist and a cardiologist on the basis of the patients' complaints. A diagnosis of GERD was assessed by the gastroenterologist clinically. All patients also underwent upper gastrointestinal endoscopy.Results: The patients were included in two groups: 61 patients with GERD (group I) and 74 patients without GERD (group II), with demographic data of 41% male, age 61.5±9 years, and body mass index (BMI) 28.8±4 kg/ m 2 versus 46% male, age 58±9 years, and BMI 29±4 kg/m 2 (all p>0.05). In groups I and II the percentages of patients with AF were 33% and 39%, respectively (p=0.52). Patients with GERD had a relative risk of AF of 1.17 (95% confidence interval [CI] 0.78-1.75; p=0.34). Heart rate variability in terms of the time-domain parameter (SDNN) was statistically significantly lower in the GERD group (97.6±13.7 ms versus 139.9±44.6 ms; p=0.001). The mean value of the frequency-domain parameter (LF/HF ratio) was also lower in the GERD group (0.75±0.17 ms versus 0.76±0.24 ms), but without statistical significance (p=0.930). Conclusion: Sympathovagal balance seems to be disrupted in patients with GERD, with dominance of the parasympathetic system and an increased risk of arrhythmias, although AF was not significantly more frequent in these patients.

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Atrial fibrillation in patients with gastroesophageal reflux disease: A comprehensive review

Abstract: Although links between AF and GERD exist, large randomized clinical studies are required for a better understanding of the relationship between these two entities.

Cited by 36 publications

References 40 publications

Prevalence of gastroesophageal reflux disorder in arrhythmic patients and adjunctive effects of proton pump inhibitors on comorbid atrial fibrillation

Prevalence of gastroesophageal reflux disorder in arrhythmic patients and adjunctive effects of proton pump inhibitors on comorbid atrial fibrillation

Association of atrial fibrillation and gastroesophageal reflux disease: Natural and therapeutic linkage of the two common diseases

Atrial fibrillation and sympathovagal balance in patients with gastroesophageal reflux disease

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