International Journal of Cardiology 190 (2015) 241
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Gastroesophageal reflux and atrial fibrillation: A chicken and egg situation Hamza Duygu Near East University Hospital, Department of Cardiology, Nicosia, Cyprus
a r t i c l e
i n f o
Article history: Received 18 April 2015 Accepted 20 April 2015 Available online 22 April 2015 Keywords: Gastroesophageal reflux disease Atrial fibrillation
Dear Editor, I have read with interest the paper by Lioni L. and colleagues discussing the relationship between gastroesophageal reflux disease (GERD) and atrial fibrillation (AF) following left atrial ablation [1]. Both GERD and AF are frequently encountered in general population with a global effect on the health and quality of life. Atrial tachyarrhythmias have been reported in patients with GERD [2]. Thus, current clinical studies showed that the frequency of AF episodes was significantly reduced in patients treated for GERD with proton pump inhibitors (PPIs) [3]. A lot of hypotheses regarding the relationship between GERD and AF have been proposed over the years. The exact mechanisms for this potential relationship remain unknown with inflammation and vagal stimulation playing a possible role in the development of AF [3]. Less known, not only GERD may trigger AF, but also AF may determine the occurrence of GERD. It was speculated that an enlarged and fibrillating left atrium may compress or irritate the neighboring lower esophagus [4]. Hiatal hernia may favor the occurrence of GERD or may aggravate pre-existing GERD in some patients. We reported a case of
E-mail address: [email protected].
http://dx.doi.org/10.1016/j.ijcard.2015.04.168 0167-5273/© 2015 Elsevier Ireland Ltd. All rights reserved.
persistent AF resistant to pharmacological and direct-current cardioversion which converted to sinus rhythm with PPI treatment for paraesophageal hernia and GERD [5]. These arrhythmias may be induced by a mechanical effect on the left atrial wall that is related to the passage of food [2]. If the hernia remained in the chest for long periods, compression of the left atrium by the hernia may have produced an area of relative ischemia and anatomical block, resulting in re-entry [2]. Schilling et al. [2] demonstrated suppression of atrial flutter by repair of a large paraesophageal hernia. In this context, to investigate the presence of hiatal hernia accompanying GERD would be useful in this particular study by Lioni et al. In conclusion, hiatal hernia and GERD should be investigated as a potential pathogenetic mechanism in patients with AF. It is crucial to extend the research in this field for better understanding the relationship between AF and GERD.
Conflict of interest None.
References [1] L. Lioni, K.P. Letsas, M. Efremidis, K. Vlachos, D. Karlis, D. Asvestas, C.C. Mihas, A. Sideris, Gastroesophageal reflux disease is a predictor of atrial fibrillation recurrence following left atrial ablation, Int. J. Cardiol. 183 (2015) 211–213, http://dx.doi.org/10. 1016/j.ijcard.2015.01.083. [2] R.J. Schilling, G.C. Kaye, Paroxysmal atrial flutter suppressed by repair of a large paraesophageal hernia, Pacing Clin. Electrophysiol. 21 (1998) 1303–1305. [3] K. Lin, X. Chen, L. Zhang, Y. Wang, Z. Shan, Proton pump inhibitors as also inhibitors of atrial fibrillation, Eur. J. Pharmacol. 718 (1–3) (2013) 435–440. [4] P. Velagapudi, M.K. Turagam, M.A. Leal, A.G. Kocheril, Atrial fibrillation and acid reflux disease, Clin. Cardiol. 35 (2012) 180–186. [5] H. Duygu, F. Ozerkan, S. Saygi, S. Akyüz, Persistent atrial fibrillation associated with gastroesophageal reflux accompanied by hiatal hernia, Anadolu Kardiyol Derg. 8 (2) (2008) 164–165.
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Gastroesophageal reflux and atrial fibrillation: A chicken and egg situation Hamza Duygu Near East University Hospital, Department of Cardiology, Nicosia, Cyprus
a r t i c l e
i n f o
Article history: Received 18 April 2015 Accepted 20 April 2015 Available online 22 April 2015 Keywords: Gastroesophageal reflux disease Atrial fibrillation
Dear Editor, I have read with interest the paper by Lioni L. and colleagues discussing the relationship between gastroesophageal reflux disease (GERD) and atrial fibrillation (AF) following left atrial ablation [1]. Both GERD and AF are frequently encountered in general population with a global effect on the health and quality of life. Atrial tachyarrhythmias have been reported in patients with GERD [2]. Thus, current clinical studies showed that the frequency of AF episodes was significantly reduced in patients treated for GERD with proton pump inhibitors (PPIs) [3]. A lot of hypotheses regarding the relationship between GERD and AF have been proposed over the years. The exact mechanisms for this potential relationship remain unknown with inflammation and vagal stimulation playing a possible role in the development of AF [3]. Less known, not only GERD may trigger AF, but also AF may determine the occurrence of GERD. It was speculated that an enlarged and fibrillating left atrium may compress or irritate the neighboring lower esophagus [4]. Hiatal hernia may favor the occurrence of GERD or may aggravate pre-existing GERD in some patients. We reported a case of
E-mail address: [email protected].
http://dx.doi.org/10.1016/j.ijcard.2015.04.168 0167-5273/© 2015 Elsevier Ireland Ltd. All rights reserved.
persistent AF resistant to pharmacological and direct-current cardioversion which converted to sinus rhythm with PPI treatment for paraesophageal hernia and GERD [5]. These arrhythmias may be induced by a mechanical effect on the left atrial wall that is related to the passage of food [2]. If the hernia remained in the chest for long periods, compression of the left atrium by the hernia may have produced an area of relative ischemia and anatomical block, resulting in re-entry [2]. Schilling et al. [2] demonstrated suppression of atrial flutter by repair of a large paraesophageal hernia. In this context, to investigate the presence of hiatal hernia accompanying GERD would be useful in this particular study by Lioni et al. In conclusion, hiatal hernia and GERD should be investigated as a potential pathogenetic mechanism in patients with AF. It is crucial to extend the research in this field for better understanding the relationship between AF and GERD.
Conflict of interest None.
References [1] L. Lioni, K.P. Letsas, M. Efremidis, K. Vlachos, D. Karlis, D. Asvestas, C.C. Mihas, A. Sideris, Gastroesophageal reflux disease is a predictor of atrial fibrillation recurrence following left atrial ablation, Int. J. Cardiol. 183 (2015) 211–213, http://dx.doi.org/10. 1016/j.ijcard.2015.01.083. [2] R.J. Schilling, G.C. Kaye, Paroxysmal atrial flutter suppressed by repair of a large paraesophageal hernia, Pacing Clin. Electrophysiol. 21 (1998) 1303–1305. [3] K. Lin, X. Chen, L. Zhang, Y. Wang, Z. Shan, Proton pump inhibitors as also inhibitors of atrial fibrillation, Eur. J. Pharmacol. 718 (1–3) (2013) 435–440. [4] P. Velagapudi, M.K. Turagam, M.A. Leal, A.G. Kocheril, Atrial fibrillation and acid reflux disease, Clin. Cardiol. 35 (2012) 180–186. [5] H. Duygu, F. Ozerkan, S. Saygi, S. Akyüz, Persistent atrial fibrillation associated with gastroesophageal reflux accompanied by hiatal hernia, Anadolu Kardiyol Derg. 8 (2) (2008) 164–165.
