The connection between atrial fibrillation and the stomach

Today I again wanted to write about atrial fibrillation (AF) and in particular explore the connection between AF and how gastric issues could be associated with an increased likelihood of AF

We know that gastric issues are extremely common in people these days and in particular many people suffer from hiatal hernia which means that part of the stomach can protrude through into the chest cavity and as this can actually mechanically compress on the left atrium and therefore increase likelihood of atrial heart rhythm disturbances.

There is an interesting study that I came across in the Journal of Afib from 2013 by Roy et al and what they wanted to find out whether people with a hiatus hernia have a much higher prevalence of atrial fibrillation. They looked at all patients who had a diagnosis of hiatus hernia and had been seen at the Mayo clinic in Rochester from Jan 1st 1976 to 31st dec 2006 and they also looked to see if they also had a diagnosis of AF. They then compared to this ti the reported prevalence of AF in patients of similar age and gender in the general population.

What they found was very intesting indeed. In younger men aged less than 55 years, AF was present in 3.5% of the population with hiatal hernia and only in 02% of the general population..I.e a 17.5 fold higher!

 

Men 55-59 years 7.8 fold increase
60-64 years 5.9 fold increase
65-69 years 4 fold increase
70-74 years 2.4 fold increase
75 – 85 years 1.2 fold increase

Similarly in women under the age of 55, there was a 19 fold higher incidence of AF compared to the general population.

Women 55-59 11.7 fold increase
60-64 years 5.9 fold increase
65-69 4 fold increase
70-74 2.4 fold increase
75-79 2 fold increase
80-84 1.6 fold increase

So it appears that in some way hiatus hernia is associated with increased prevalence of atrial fibrillation. However association does not automatically imply causation; and therefore I was keen to see if there was any evidence that treating the hiatus hernia can improve AF.

I found a few interesting case reports in the literature suggesting possible causation.
Schilling et al reported a case of patient who had atrial flutter and a large paraesophageal hernia and once the patient had an operation to repair the hernia he had no more atrial flutter.

There was another case of paroxysmal flutter that didn’t respond to an even ablation but once he was started on PPIs sinus rhythm was maintained at 1 year of follow-up

I also found another case where a patient with a large paraesophageal hiatus hernia regularly developed Afib after eating found that his symptoms disappeared after he had sugery

The mechanisms by which the hiatus hernia could cause AF are 3;
1. Mechanical compression
2. Inflammation
3. Increased vagal tone from the reflux could cause AF

So I hope this was useful for you. Here is a link to my video on this subject

 

 

 

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