Gastroesophageal reflux disease and atrial fibrillation: Insight from autonomic cardiogastric neural interaction

Abstract

Background The relationship between gastroesophageal reflux disease (GERD) and atrial fibrillation (AF) has been previously reported. However, the detailed mechanism remains unknown. In this study, we investigated the effects of acid reflux on the intrinsic cardiac autonomic nervous system, atrial/ventricular electrophysiology, and AF inducibility. Methods Eighteen rabbits were randomized into three groups: acid reflux (group 1, n = 6), control (group 2, n = 6), and acid reflux with periesophageal vagal blockade (group 3, n = 6). Atrial and ventricular effective refractory periods (ERPs) and AF inducibility were checked at baseline and then hourly until 5 hours after the experiment. Results Three hours after the experiment, atrial ERP prolongation was noted in groups 2 and 3 (P < .05), whereas shortening of the atrial ERPs was observed in group 1, compared with the baseline. However, no changes were observed in ventricular ERPs in the three groups. The AF inducibility was higher in group 1 than in groups 2 and 3. Pathological examination showed clear esophageal mucosal breaks in groups 1 and 3. Conclusions In this study, we found that the antimuscarinic blockade prevents GERD induced changes to atrial electrophysiology and susceptibility to AF—making it highly likely that autonomic activity is important in mediating this effect.

Objectively confirmed gastroesophageal reflux disease and risk of atrial fibrillation: a population-based cohort study in Sweden

“…The main treatment options are medication using a proton pump inhibitor (PPI) or surgery with laparoscopic fundoplication, although medication is dominating [1, [4][5][6]. It has been suggested that GERD increases the risk of atrial fibrillation, possibly due to increased vagal activity or local acid irrigation, which leads to an inflammatory reaction of the surrounding tissue influencing the conduction system of the heart [7,8]. However, the results of studies that have examined the association between GERD and atrial fibrillation have been inconclusive.…”

Renal artery denervation prevents ventricular arrhythmias in long QT rabbit models

“…Our study revealed comparable results with trends of VERP prolongation and significant reduction of VA inducibility. In addition, the administration of anesthetic agents was an important consideration during the experimental procedure 16 , 17 . It is suggested that the pentobarbital agents may potentially affect the circadian and cardiac rhythm leading to confounding results.…”

Higher premature atrial complex burden from the Holter examination predicts poor cardiovascular outcome

“…PACs, as precursors arising in the thoracic veins 2 – 4 , are important for initiation and perpetuation of AF, and the main focal mechanisms of PAC, including enhanced automaticity, early afterdepolarization, or delayed afterdepolarization, are highly related to adrenergic activation 16 , which is usually provoked by chronic inflammation 17 . Chronic inflammation is closely associated with AF 18 , which is well-known as a risk factor for cardiovascular death.…”