Acid Reflux = Arrhythmia

[Peter__0__0]

  Hello I posted several messages last spring about the possible connection
  between atrial arrythmias and GERD.  Briefly my story is a typical one where
  being an otherwise healthy 38 year old male with no heart history, I suddenly
  began experiencing atrial arrythmias 5 years ago.  I have done all the tests, including
  an electrophysiology study.  All tests show no problem and everyone says I
  shouldn't have this problem.  I have had 3 separate bouts of afib that needed
  meds to convert.  A weird correlation with swallowing became very obvious.  Every
  time I swallow the rhythm would pause and then respond with a rapid flurry of beats.
  This would be most pronounced during exercise such as running when I could watch my
  heart rate change from 140 to 240 immediately after swallowing.  The rate would
  return to 140 with 3 or 4 seconds.  I asked for a Barium swallow and after
  some insisting had it done.  The results show significant reflux (actually the worst my
  family doctor had ever seen).  After being on Pantaloc and Prepulsid (treat the reflux)
  the arrythmia went away.  I have resumed a completely normal lifestyle including strenuous
  exercise.  This after being told I would be on meds the rest of my life with possible
  AV ablation in the future.  I have been off the reflux meds for about 4 months and I am now
  beginning to feel the return of the swallow-induced arrythmia (no afib).  I started the
  reflux med (Pantaloc) on my own and the arrythmia is once again disappearing.  It seems
  certain foods, and stress contribute to the arrythmia (classic reflux symptoms also).  I know
  the connection is not by chance or some coincidence.  So my question is:  Has any research
  into this connection been initiated by anyone?  I wonder if a permanent solution exists.
  I have come accross many others with similar stories.  I sure think this is worthy of some
  study.  Please respond.

[CCF Cardio MD - MTR]

Dear Peter, thank you for your question.  Interestingly, there have been several recent questions to the heart forum on the same topic you ask about so I suggest that you read those questions and responses for more information.  No specific research has been done on the relationship of acid reflux to atrial arrhythmias to my knowledge.  I even did a computerized search of the medical literature back to 1965 and I could find no references on this subject.  However, there may be a pathophysiologic relationship between the two conditions relating to the activity of the vagus nerve.  The vagus nerve innervates both the heart and the digestive tract so an overactive vagus nerve could conceivably precipitate both reflux and atrial arrhythmias.  Until effective reflux medications became available, treatment for severe gastroesophageal relfux was ligation of the vagus nerve and resection of the portion of the stomach that produces the most acid.  Such treatment would be too drastic for your problem.  Non-pharmacologic measures to treat reflux consist of avoiding tobacco, alcohol, and caffeine, elevating the head of the bed 4-6 inches, and avoiding food for 3 hrs. before sleep.  Stress certainly can exacerbate reflux so stress management may also help.  Finally, there are powerful medictions to drastically reduce gastric acid secretions (prilosec and prevacid) that may also help.  I think that better treatment of your reflux should control your atrial arrhythmias.  
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.