Treating Acid Reflux May Increase Atrial Fibrillation Ablation Success

Gastroesophageal reflux disease (GERD) and atrial fibrillation (AF) are 2 of the most significant health concerns in the United States, and researchers suspect a link between them.

Pathologic reflux often follows left atrial (LA) ablation, but the prognostic significance of GERD on LA ablation outcomes hasn’t been examined. Now, a small study published in the International Journal of Cardiology has shed some light on AF recurrence after a single LA ablation procedure for paroxysmal AF.

These researchers enrolled 88 consecutive patients with symptomatic, drug-refractory paroxysmal AF who underwent LA ablation. They noted a presumptive diagnosis of GERD if patients reported typical symptoms of heartburn and regurgitation, had diagnosed erosive esophagitis, or had taken proton pump inhibitor (PPI) therapy for 8 weeks. Patients with more complicated symptom constellations, such as dysphagia, hematemesis, and weight loss, were excluded.

Patients were monitored with ambulatory cardiac monitors for 24 to 48 hours after their LA ablation, while referring cardiologists saw the patients 1, 6, and 12 months after the ablation procedure. The cardiologists counseled patients to report symptoms of arrhythmia between scheduled visits. The researchers screened for recurrent or newly developed GERD symptoms and PPI treatment during the follow-up period.

Twenty subjects (22.7%) met the study criteria for GERD and received PPI therapy. All 88 subjects proceeded with AF ablation and were free of reflux when they underwent the procedure. Following a mean follow-up period of 8 months, 63 patients (71.6%) remained in sinus rhythm.

Patients with AF recurrence displayed increased maximum P-wave duration, P-wave dispersion, and larger left atrial diameter (LAD). They were also more likely to have hypertension, coronary artery disease, and GERD compared with those who remained in sinus rhythm.

After constructing a multiple logistic regression model, the researchers found that only GERD and larger LAD were independently linked to AF recurrence. In fact, a GERD diagnosis was associated with 8 times the risk of AF recurrence.

This was the first study to show that GERD independently predicts AF recurrence after LA ablation for paroxysmal AF. Potential causes include:

· Chronic inflammation

· Local esophageal mucosa inflammation that may affect the adjacent vagal nerves and local afferent—efferent reflex mechanisms

· Autonomic imbalance that may initiate and perpetuate AF

· Release of inflammatory mediators

Empiric therapy with PPI may increase the overall success rate of AF catheter ablation in patients with documented GERD. Future studies should validate this hypothesis.