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OBJECTIVE EVALUATION OF GASTROESOPHAGEAL REFLUX DISEASE IN PATIENTS WITH PAROXYSTIC ATRIAL FIBRILLATION
Enia Coutinho2, Fernando A. M. Herbella*1, Carlos A. Lovatto2, Angelo A. DePaola2, Marco G. Patti3
1Department of Surgery, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil; 2Department of Medicine, Division of Cardiology, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil; 3Department of Surgery, University of North Carolina, Chapel Hill, NC
Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. AF usually occurs when structural and/or electrophysiologic abnormalities alter atrium tissue to promote abnormal impulse formation and/or propagation. Some evidence shows that gastroesophageal reflux disease (GERD) may be a trigger for paroxystic AF (PAF) in patients without clinical structural and/or electrophysiologic abnormalities. Most of the previous studies that correlated GERD and AF used questionnaires to assess GERD, not an objective evaluation.
Aims: This study aims to evaluate in patients with PAF: (a) the accuracy of symptoms to diagnose GERD; (b) the prevalence of GERD based on an objective evaluation, and (c) the temporal correlation between AF and episodes of reflux.
Methods: A population of 22 patients based on a sample size calculation (59% females, mean age 68 years) with PAF underwent esophageal manometry followed by ambulatory pH monitoring and concurrent Holter. Eight (36%) patients had GERD symptoms. Patients were grouped as GERD + or GERD - based on DeMeester score. Temporal correlation between cardiac arrhythmia and episodes of reflux were recorded.
Results: Six (27%) patients were GERD +. GERD symptoms had sensitivity and specificity of 50% and 70%, respectively, for the diagnosis of GERD. Thirteen AF episodes occurred during the test in 7 (32%) patients, 3 (43%) of them had GERD. PAF occurred in 2 (0% GERD+) patients and AF persistent during the period of the test in 5 (60% GERD+). The correlation between AF and episodes of reflux in the 2 patients with PAF was 0 and 14%.
Conclusions: Our results show that in patients with AF: (a) symptoms have a low accuracy for the diagnosis of GERD; (b) the prevalence of GERD in patients with PAF is low and not different from the general population; and (c) temporal correlation between episodes of reflux and AF is low.
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