Table 1.
Studies to Date on Atrial Fibrillation and Acid Reflux Disease
| Study Authors | Nature of the Study | No. of Patients | Methodology | Results | Conclusion |
|---|---|---|---|---|---|
| Tougas et al, 199722 | Observational, prospective. | Fourteen healthy volunteers | Heart rate variability was compared at rest and during esophageal stimulation, using either electrical or mechanical stimuli. | Decreased heart rate (both electrical and mechanical) (P < 0.005), and altered heart rate variability (P < 0.001). Increased absolute and normalized area of the high‐frequency band within the power spectrum (P < 0.001). Decreasing the low‐frequency power (P < 0.005). | Esophageal stimulation (electrical or mechanical) appears to amplify respiratory‐driven cardiac vagoafferent modulation while decreasing sympathetic modulation. |
| Weigl et al, 200330 | Observational, retrospective. | Eighteen patients with paroxysmal AF. | Upper endoscopic examination showed that 14 patients had esophagitis and the other 4 had Barrett esophagus. All patients received daily or twice‐daily PPI therapy. | Decrease or disappearance of at least 1 PAF‐related symptom occurred in 14 of 18 patients (78%) after PPI therapy. In 2 of the remaining 4 patients, GERD‐related symptoms persisted. Antiarrhythmic drugs were discontinued in 5 patients, and none had to be increased in dosage or newly prescribed. ECG showed sinus rhythm in all patients. | GERD should be investigated as a potential pathogenetic mechanism in lone PAF. PPI therapy reduces not only GERD‐related but also PAF‐related symptoms. |
| Cuomo et al, 200631 | Observational, prospective. | Thirty‐two patients with GERD and dysarrhtyhmias and 9 with GERD. | Power spectrum analysis of heart rate variability was obtained with both its LF (sympathetic modulation) and HF (vagal modulation) components. Hourly mean esophageal pH and LF/HF ratio (esophagus‐heart) were correlated. A 3‐month regimen of esomeprazole 40 mg/day was prescribed. | In 8 (56%) of the 32 patients with dysrhythmia and in none with GERD only, a significant correlation between esophageal pH and LF/HF ratio was observed. A significant reduction of cardiac symptoms after PPI therapy was observed only in these patients (13/16 vs 4/11, P < 0.01). | Subgroup of dysrhythmic patients in whom the esophageal acid stimulus elicited cardiac autonomic reflexes. In these patients, acid suppression seems to improve GERD and cardiac symptoms. |
| Gerson et al, 200632 | Observational, prospective. | All 3 patients had heartburn, acid regurgitation, and palpitations occurring at least weekly and reported a potential association between the palpitations and GERD symptoms. | The patients underwent simultaneous 24‐hour esophageal ambulatory pH and Holter monitoring off of antireflux therapy for at least 7 days to investigate a potential relationship between GERD symptoms and the presence of cardiac arrhythmic events. | All of the patients reported a reduction in arrhythmia symptoms on PPI. | Atrial arrhythmia and reflux should have a trial of aggressive acid suppressive therapy. |
| Bunch et al, 200834 | Observational, prospective. | A total of 5288 residents (age 25–74 years) of Olmsted County, Minnesota, to assess the presence and frequency of GERD from 1988–1994. | A self‐report questionnaire was mailed to a random sample. | GERD was not associated with risk for AF (HR: 0.81, 95% CI: 0.68–0.96, P = 0.014) after adjustment for other risk factors. Patients with more frequent GERD had a slightly higher nonsignificant AF risk. Esophagitis increased the risk for AF (HR: 1.94, 95% CI: 1.35–2.78, P < 0.001), but the association did not persist when accounting for other risk factors. | No association was found with the presence of GERD or the frequency of symptoms and AF. Patients with esophagitis were more likely to develop AF. |
| Kunz et al, 200935 | Retrospective. | There were 163627 patients of which 7992 (5%) had AF and 47845 (29%) had GERD. | Database containing all healthcare encounters for patients who received ambulatory care in the National Capitol Region military healthcare system between January 1, 2001 and October 28, 2007. | The presence of GERD increased the RR of a diagnosis of AF (RR: 1.39, 95% CI: 1.33–1.45). In sensitivity analyses, this relationship persisted after adjustment for cardiovascular disease risk factors (RR: 1.19, 95% CI: 1.13–1.25) and diagnoses known to be strongly associated with AF (RR: 1.08, 95% CI: 1.02–1.13). | GERD is associated with an increased risk of a diagnosis of AF. |
| Shimazu et al, 201136 | Retrospective. | There were 188 subjects treated for GERD as outpatients | Patients were classified by the frequency scale for symptoms of GERD (F scale). | Total scores on the F scale were significantly greater in patients with AF (P = 0.019) compared to other subjects. Univariate and multivariate analysis of the prevalence of GERD demonstrated AF alone showed a significant (P < 0.001) correlation with GERD. | AF was an independent risk factor for GERD. |
Abbreviations: AF, atrial fibrillation; CI, confidence interval; ECG, electrocardiogram; GERD, gastroesophageal reflux disease; HF, high frequency; HR, hazard ratio; LF, low frequency; PAF, paroxysmal atrial fibrillation; PPI, proton pump inhibitor; RR, relative risk.