Proton pump inhibitor use is not associated with cardiac arrhythmia in critically ill patients

Abstract

Hypomagnesemia can lead to cardiac arrhythmias. Recently, observational data has linked chronic proton pump inhibitor (PPI) exposure to hypomagnesemia. Whether PPI exposure increases the risk for arrhythmias has not been well studied. Using a large, single center inception cohort of critically ill patients, we examined whether PPI exposure was associated with admission electrocardiogram (ECG) readings of a cardiac arrhythmia in over 8000 patients. There were 24.5% PPI users while 6% were taking a histamine 2 antagonist. 14.3% had a cardiac arrhythmia. PPI use was associated with a 1.18 (95% CI=1.02–1.36, p=0.02) unadjusted and 0.96 (95% CI=0.83–1.12, p=0.62) adjusted risk of arrhythmia. Amongst diuretic users (n=2468), PPI use was similarly not associated with an increased risk of cardiac arrhythmia. In summary, in a large cohort of critically ill patients, PPI exposure is not associated with an increased risk of cardiac arrhythmia.

Proton Pump Inhibitor Use Before ICU Admission Is Not Associated With Mortality of Critically Ill Patients

“…Moreover, researchers also found that PPIs could prevent atrial fibrillation 20‐22 with the help of antioxidative 23 and anti‐inflammatory 24 effects, but it is still controversial whether the use of PPIs is a risk factor 25 for or an inhibitor of atrial fibrillation. Similarly, studies in critically ill patients also showed extraneous associations between PPI exposure and Clostridium difficile infection, 26 acute kidney injury, 16 and cardiac arrhythmia 27 . In addition, researchers could not find a significant association between PPI use and acute kidney injury in patients with hypomagnesemia 16 .…”

Magnesium Deficiency and Proton‐Pump Inhibitor Use: A Clinical Review

“…However, a recent study examined PPI exposure and the risk of arrhythmias, hypothesizing that if PPI use leads to chronic decreased magnesium absorption, and therefore magnesium deficiency, PPI use should be associated with an increased risk of arrhythmias. However, in 8000 patients admitted to a single‐center intensive care unit, PPI use was not associated with an increased risk of arrhythmia . Given the difficulty in accurately measuring magnesium homeostasis, as described earlier, it is at least plausible that chronic PPI use might lead to intracellular magnesium depletion while not affecting serum magnesium concentrations.…”

Atrial fibrillation and gastrooesophageal reflux disease: association mechanisms, treatment approaches

“…Ряд авторов считают, что кислотосупрессивная терапия, применяемая для лечения ГЭРБ, оказывает положительные эффекты при ФП [29]. Ингибиторы протонной помпы (ИПП) могут представлять собой дополнение к стандартному антиаритмическому лечению за счет улучшения симптомов, связанных с ФП [7,8,30] (табл. 1), и облегчения восстановления синусового ритма, с тем преимуществом, что они менее дороги и имеют меньше побочных эффектов [31].…”