Effect of cardio-gastric interaction on atrial fibrillation in GERD patients

Yıl 2023, Cilt 50, Sayı 3, 304 - 310, 15.09.2023

Serhat Günlü Eşref Araç Adem Aktan Fethullah Kayan Bernas Altıntaş Mehmet Zülkif Karahan

https://doi.org/10.5798/dicletip.1360607

Öz

Objective: Atrial fibrillation (AF) and gastroesophageal reflux disease (GERD) are very common in daily clinical practice. Post-prandial AF episodes have been reported in GERD patients. Although it was reported in previous studies that it was caused by sympathovagal imbalance, there are no studies on cardiac conduction system involvement. In this study, we aimed to evaluate whether the risk of developing AF increases in untreated GERD patients with non-invasive electrophysiological tests.
Methods: The research was prospectively performed. Endoscopy was performed on the individuals due to reflux complaints. ECG was recorded at 25mm/s and 10 mm/mV amplitude, and 24-hour Holter ECG (three-channel; V1, V2, and V5) was performed. ECG parameters were measured and Holter ECG results were analyzed.
Results: A total of 120 individuals, 60 patients and 60 controls, were included. No significant statistically differences existed between groups for hypertension, diabetes, smoking, or dyslipidemia (p>0.05). In terms of heart rate, Pmax, Pmin, QTd, and QTcd, there were no significant differences across the two groups (p>0.05). P-wave dispersion (Pd) was substantially higher in the study group (p=0.014). Comparing the heart rate variabilities of 24-hour Holter ECG recordings across the groups, the standard deviation of R-R intervals (SDNN) was substantially higher in the study group (p<0.001). Low Frequency (LF) and LF/HF were significantly higher in the control group (p<0.001 and p=0.003, respectively). AF was detected in nine individuals on Holter ECG.
Conclusion: Pd duration and risk of developing AF were higher in GERD patients.

Anahtar Kelimeler

Atrial fibrillation, heart rate variability, gastroesophageal reflux, Holter-ECG

Kaynakça

• 1.Kjerpeseth LJ, Igland J, Selmer R, et al. Prevalenceand incidence rates of atrial fibrillation in Norway2004-2014. Heart. 2021; 107: 201-7.
• 2.Cheung CC, Nattel S, Macle L, Andrade JG.Management of Atrial Fibrillation in 2021: AnUpdated Comparison of the Current CCS/CHRS, ESC,and AHA/ACC/HRS Guidelines. Can J Cardiol. 2021;37: 1607-18.
• 3.Şenöz O, Kış M, Güzel T. Akut serebrovasküler olaygeçiren hastalarda acef risk skoru ile aritmi gelişimiarasındaki ilişki. İzmir Eğitim ve AraştırmaHastanesi Tıp Dergisi. 2022; 26: 183-9.
• 4.Kış M, Güzel T. Akut iskemik serebrovasküler olaygeçiren hastalarda aritmi sıklığının holterelektrokardiyografi ile değerlendirilmesi. Ege TıpDergisi. 2022; 61: 284-90.
• 5.Bizhanov KA, Аbzaliyev KB, Baimbetov AK,Sarsenbayeva AB, Lyan E. Atrial fibrillation:Epidemiology, pathophysiology, and clinicalcomplications (literature review). J CardiovascElectrophysiol. 2023; 34: 153-65.
• 6.Güzel T, Kış M, Şenöz O. The correlation betweenthe left atrial volume index and atrial fibrillationdevelopment in heart failure with mildly reducedejection fraction and long-term follow-up results.Acta Cardiol. 2022; 77: 647-54.
• 7.Romiti GF, Pastori D, Rivera-Caravaca JM, et al.Adherence to the 'Atrial Fibrillation Better Care'Pathway in Patients with Atrial Fibrillation: Impacton Clinical Outcomes-A Systematic Review andMeta-Analysis of 285,000 Patients. Thromb Haemost. 2022; 122: 406-14.
• 8.Ma G, Wang X, Han Z, Zhang C, Zheng Q. Successfulnon-operative management of atrioesophagealfistula after combined therapy of catheter ablationand left atrial appendage closure for atrialfibrillation: A case report [published online ahead ofprint, 2022 Nov 19]. Pacing Clin Electrophysiol.2022; 10.1111/pace.14624.
• 9.Jaganathan S. Acute superior mesenteric arterialthromboembolic occlusion-catheter directedthrombolysis-be on time, still be cautious!International Surgery Journal. 2022; 9: 2062-5.
• 10.Linz D, Hohl M, Vollmar J, et al. Atrial fibrillationand gastroesophageal reflux disease: thecardiogastric interaction. Europace. 2017; 19: 16-20.
• 11.Günlü S, Aktan A. The association betweenfrequent premature atrial contractions andrecurrent stroke in a population of ischemic stroke.Dicle Tıp Dergisi. 2022; 49: 571-8.
• 12.Hindricks G, Potpara T, Dagres N, et al. 2020 ESCGuidelines for the diagnosis and management ofatrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery(EACTS): The Task Force for the diagnosis andmanagement of atrial fibrillation of the EuropeanSociety of Cardiology (ESC) Developed with thespecial contribution of the European Heart RhythmAssociation (EHRA) of the ESC. Eur Heart J. 2021; 42: 373-498.
• 13.Khan AA, Lip GYH, Shantsila A. Heart ratevariability in atrial fibrillation: The balance between sympathetic and parasympathetic nervous system.Eur J Clin Invest. 2019; 49: e13174.
• 14.Günlü S, Aktan A. Cardiac arrhythmias,conduction system abnormalities, and autonomictone in patients with brucellosis. Eur Rev MedPharmacol Sci. 2022; 26: 9473-9.
• 15.Leung LWM, Akhtar Z, Elbatran AI, et al. Effect ofesophageal cooling on ablation lesion formation inthe left atrium: Insights from Ablation Index data inthe IMPACT trial and clinical outcomes. J CardiovascElectrophysiol. 2022; 33: 2546-57.
• 16.Ma Y, Cai R, Liu Z, Zou X, Qiao Z. Clinical efficacyand mechanism of transcutaneous neuromodulation on ineffective esophageal motility in patients withgastroesophageal reflux disease. Neurogastroenterol Motil. 2023; 35: e14464.
• 17.Teres C, Soto-Iglesias D, Penela D, et al.Relationship between the posterior atrial wall andthe esophagus: esophageal position andtemperature measurement during atrial fibrillationablation (AWESOME-AF). A randomized controlledtrial. J Interv Card Electrophysiol. 2022; 65: 651-61.
• 18.Mulia EPB. Roemheld syndrome: Apprehendingarrhythmia in a different perspective.Cardiovascular Surgery and Interventions. 2022; 9:64-5.
• 19.Monsour M, Croci DM, Agazzi S, Borlongan CV.Contemplating IL-6, a double-edged sword cytokine: Which side to use for stroke pathology? CNSNeurosci Ther. 2023; 29: 493-7.
• 20.Gharagozloo F, Meyer M, Poston R.Cardiovascular Complications of Large HiatalHernias: Expanding the Indications for RoboticSurgical Anatomic and Physiologic Repair: A Review. World Journal of Cardiovascular Surgery. 2022; 12:39-69.
• 21.Roy RR, Sagar S, Bunch TJ, et al. Hiatal Hernia IsAssociated With an Increased Prevalence of AtrialFibrillation in Young Patients. J Atr Fibrillation.2013; 6: 894.
• 22.Zarea AT, Ahmed HM, Ahmed LA. CardiacInvolvement in Patients with GastroesophagealReflux Disease (GERD). Afro-Egyptian Journal ofInfectious and Endemic Diseases. 2022; 12: 66-74.
• 23.George SK, Tlou B, Ponnusamy S, Naidoo DP.Does acid reflux precipitate ischaemia in subjectswith acute coronary syndrome? Cardiovasc J Afr.2020; 31: 65-70.
• 24.Bodur O, Yılmaz AS, Akdoğan R, et al. Esophagitisand gastritis are associated with premature atrialcontractions in patients with gastroesophageal reflux disease. Cardiovasc Surg Int. 2021; 8: 109-15.
• 25.Tasci O, Kiran Tasci E. Does the use of protonpump inhibitors in children affect ventricularrepolarisation parameters? Cardiol Young. 2022; 1-5.
• 26.Kaya H, Barutçu S. Gastroesophageal refluxdisease is associated with abnormal ventricularrepolarization indices. Turk J Gastroenterol. 2019;30: 1021-4.
• 27.Ali MK, Chen JDZ. Roles of Heart Rate Variabilityin Assessing Autonomic Nervous System inFunctional Gastrointestinal Disorders: A SystematicReview. Diagnostics (Basel). 2023; 13: 293.
• 28.Syrine G, Mariem MK, Hend K, Imed L.Relationship Between Esophageal MotilityDisorders and Autonomic Nervous System inDiabetic Patients: Pilot North African Study. Am JMens Health. 2022; 16: 15579883221098588.
• 29.Rebecchi M, Panattoni G, Edoardo B, et al. Atrialfibrillation and autonomic nervous system: Atranslational approach to guide therapeutic goals. JArrhythm. 2021; 37: 320-30.
• 30.Zarea AT, Ahmed HM, Ahmed LA. CardiacInvolvement in Patients with GastroesophagealReflux Disease (GERD). Afro-Egyptian Journal ofInfectious and Endemic Diseases. 2022; 12: 66-74.
• 31.Wang AM, Wang G, Huang N, et al. Associationbetween laryngopharyngeal reflux disease andautonomic nerve dysfunction. Eur ArchOtorhinolaryngol. 2019; 276: 2283-7.
• 32.Maruyama T, Fukata M, Akashi K. Association ofatrial fibrillation and gastroesophageal refluxdisease: Natural and therapeutic linkage of the twocommon diseases. J Arrhythm. 2018; 35: 43-51.
• 33.Tuerxun K, Balati M, Aimaiti M, et al.Epidemiological investigation, extraesophagealsymptoms and risk factors of gastroesophagealreflux disease in Kashgar, Xinjiang, China. Am JTransl Res. 2021;13:14186-94.