Background
This retrospective cohort study aims to investigate the relationship between hiatal hernia repair and anti-reflux surgery with resolution of supraventricular arrhythmia at 1 year post-operatively. Current literature has shown that patients with gastroesophageal reflux disease (GERD) and/or hiatal hernia (HH) have an increased incidence of atrial fibrillation. However, there is a gap in the literature investigating the effect of surgical HH correction on cardiac arrhythmias. We hypothesize that the rate of supraventricular arrhythmias among patients with a HH and/or GERD will decrease within the first year following hernia repair with the resolution of GERD symptoms.
Methods
The charts of 538 consecutive patients who received HH repairs between July 2018 to June 2023 were reviewed. Patients were included in the study if they had a supraventricular arrhythmia diagnosed at the time of surgery, did not have any type of permanent pacing device, and had at least 1 year of close follow up. Within this population, 21 patients met these criteria. Data from patient charts were retrospectively collected, including demographics, antiarrhythmic and anticoagulation treatment, and arrhythmia symptoms at the time of surgery and within the first year after hernia repair. Improvement in arrhythmia was defined as the ability to discontinue anticoagulation or antiarrhythmic treatment or cessation of symptoms experienced prior to hernia repair and anti-reflux surgery.
Results
There were 21 patients who met the inclusion criteria. The average age of our cohort was 65.8 years and average time with HH before repair was 2.8 years. Nine of these patients were on anticoagulation before surgery of which two were able to discontinue apixaban. Eleven patients were on an antiarrhythmic before surgery, and 2 were able to discontinue this treatment within 1 year post-operatively. Finally, 3 out of 10 patients with symptomatic palpitations had resolution of these symptoms after hernia repair.
Conclusion
Among the 21 patients that met study inclusion criteria, 7 of these patients had improvement of their arrhythmia measured as discontinuation of antiarrhythmic medication, discontinuation of anticoagulation, or resolution of palpitations. Although our study may have a limited sample size, these results suggest HH repair and anti-reflux surgery may play an important role in the treatment of supraventricular arrhythmias. Future studies should investigate this relationship with a larger sample size, as surgical treatment for arrhythmia resolution may mitigate the need for prolonged anticoagulation in this population.
