Re: Reflux = arrhythmia

Posted By HFHSM.D.-rf on April 23, 1998 at 23:24:45:

In Reply to: Reflux = arrhythmia posted by Peter on April 15, 1998 at 22:05:16:






Hello I have posted several previous messages regarding my strange
symptom of having an atrial arrhythmia every time I swallow.  I have
been having this on and off again for the past 5 years (each time lasting
about 4 months).  Last year the arrythmia got so bad I actually suffered
atrial fibrillation and required meds and hospital intervention.  I am only
37 years old and in otherwise perfect health.  In fact I have recently run
a marathon and have lived a life of fitness and good health.  I was put on
heart meds because the rhythm was so lost at times.  Eating became very difficult
as the rhythm became so disorganized by the action of swallowing.
Well I asked for a barium swallow and it turns out I have the worst case
of reflux my doctor has ever seen.  Nobody has ever heard of it causing an
arrythmia but they put me on Pantaloc and Prepulsid to combat the problem.  
Within 5 weeks the arrythmias have disappeared altogether.  This cannot be a
simple coincidence.  In retrospect I can now explain many of my previous symptoms
in light of the reflux problem.  I have now been switched to Pepcid 20 mg twice a day.
I have been experiencing stomach pains in the upper GI area for the past 4 days.
Could the new meds be losing the battle?  Could the reflux have caused some chronic
irritation of the vagus nerve that caused the atrial arrythmia?  When I swallowed it
seemed the beat paused (vagal response) and then responded with a flurry of beats.
My doctor suggests I try the Pantaloc again by itself and if that doesn't solve the
problem I should try Prepulsid again along with the Pantaloc.  My final question is this -
I suspect my LES is not very functional.  Can it recover enough through lifestyle mod and
these meds or is surgery a viable option?  Can you stay on these meds indefinitely?  
Sorry for the long write up but it is a baffling scenario.  Thanks!




Dear Peter,
Thank you for your letter updating us regarding your condition.  I am happy to learn that a cause of your arrythmia has been identified.  With regard to your specific questions, Pepcid is not as potent a suppressor of acid as Pantaloc.  Many people with esophageal reflux will report that symptoms that have been successfully treated with proton pump inhibitors (the group of drugs of which Pantaloc is an example) can recur when switched to an H2 receptor antagonist (exemplified by Pepcid).  You may be one of those people who require indefinite treatment with a proton pump inhibitor.  There is no reason to postulate irreversible damage to esophagus or vagus nerve.  We know that acid reflux into the esophagus is a life long problem.  Medication-induced inhibition of acid prevents the symptoms but does not treat the underlying problem which is inappropriate relaxation of the lower esophageal sphincter, the muscle barrier that prevents acid reflux from stomach into esophagus.  Lifestyle modifications can also help control symptoms.  The only way to permanently improve your symptoms is surgery, but I would not suggest this approach until you have tried medical therapy for at least several months. This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician.