Gastroesophageal reflux disease and the risk of developing rhythm disorders

Introduction: Gastroesophageal reflux disease (GERD) is a motor disorder associated with impairment of the normal antireflux mechanisms (lower esophageal sphincter function, phrenoesophageal ligament), with changes in normal physiology (impaired esophageal peristalsis, increased intragastric pressure, increased abdominothoracic pressure gradient) or, very rarely, excess gastric acid secretion. Due to the close vicinity of the left atrium and oesophagus, an interaction between gastroesophageal disease and atrial fibrillation has been suggested. Atrial fibrillation (AF) is a common arrhythmia in medical practice.
Objective: To analyze the association between aAF and GERD and to discuss the possible mechanism of AF in a population of patients with GERD.
Methods: a systematic literature search using the key words „gastroesophageal reflux and atrial fibrillation“ and „peptic esophagitis and atrial fibrillation“ on Pu-bMed, EMBASE, Google Scholar databases, WILEY databases.
Results: Gastroesophageal reflux disease might in-crease by 39% risk of atrial fibrillation. Potentially involved mechanisms for the relationship between gastroesophageal reflux disease and atrial fibrillation are chemical and mechanical irritation of vagal nerve with, perioesophageal nerve plexus, oesophageal vessels and lymph nodes and atrial mechanical irritation. These le-eds to dominance of the parasympathetic system and an increased risk of arrhythmias Also, comorbidities like obesity and sleep-disordered breathing are highly prevalent in GERD-patients and may be associated with the development of atrial fibrillation by systemic changes related to these conditions. For each unit in-crease in body mass index is a 3-8% higher risk of new atrial fibrillation onset.Therapy with proton pump in-hibitors may help to ameliorate symptoms associated with AF and facilitate conversion to sinus rhythm indi-rectly suggesting a causal relationship.
Conclusions: GERD patients are at higher risk of developing AF both through direct mechanisms and the associated comorbidities.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)