My name is Sanjay Gupta and I am a consultant cardiologist and today I again wanted to talk about 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.

So there is an interesting study that I came across in the Journal of Afib form 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 so 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. So what they found was very interesting 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! Similarly in women under the age of 55, there was a 19 fold higher incidence of AF compared to the general population. 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 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 Afib.

I found a few interesting cases reports in the literature suggesting possible causation Scilling et al reported a case of a patient who had an 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 surgery.

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.

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