PVC,s SVT and relation to Hiatal hernia/ GERD

[thedude1973]

I started getting PVC's and later SVT around the age of 24.  Before that, I was an division one NCAA athlete and in the military. I had always suffered from heartburn, and reflux, and have noticed that when I had worse heartburn, I always had more PVCs.  Regarding PVC's, at my worst I was experiencing upwards of 45 in a minute for couple of hours at a time.  I had em checked out (around 1999), Cardiologist suggested antiarrythmic drugs and said nothing at all to worry about.  

I spoke with a few people and doctors around that time who said it can be vagal nerve irritation.  Even though I lived on tums they suggested I use gaviscon (a nice chalk like antacid).  Watching the diet, monitoring the heartburn/ GERD has reduced the PVC's to around 5 or 6 total a week.

I also have SVT (of which I had ablation for in 2009).  I was pretty much assymptomatic until oct 12.  I shot into a nice SVT string of upper 200s (nearing 300) bpm.  I was actually wearing a holter monitor at the request of the FAA for a pilots medical certificate because of the 2009 ablation.   The holter picked it up.  I had had two glasses of wine and had just heard some shocking news when the SVT appeared.  

That all being said, I was also diagnosed with a hiatal hernia and acid reflux around the same time this stuff started.  The reflux was pre-Barrets syndrom, meaning there was some irritation to the esphogus.  

Has anyone heard of corrolations between hiatal hernias, acid reflux and instances of PVCs or SVTs? Can the hiatal hernia's tearing of the diaghram allow the esophagus to touch the soft tissues of the heart and cause arrythmia? or in the opposite, touch the vegas nerve and cause the arrythmia?  Just wondering because Vegal manuvers can correct the SVT.  

[merv13]

Have just finsihed looking at an article decribing the possible correlation between hiatus hernia and Atrial Fibrillation. It could be that other forms of arrythmia may also be triggered by this same mechanism. The abstract is posted below:

" Atrial Fibrillation and Acid Reflux Disease"

Poonam Velagapudi, MD, MS; Mohit K Turagam, MD; Miguel A Leal, MD; Abraham G Kocheril, MD Department of Medicine (Velagapudi, Turagam), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Cardiac Electrophysiology and Cardiovascular Medicine Division, Department of Medicine (Leal), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin-53701; Division of Cardiac Electrophysiology and Cardiovascular Medicine, Department of Medicine (Kocheril), University of Illinois College of Medicine-Urbana Champaign, Urbana, Illinois
Address for correspondence:
Mohit K. Turagam, MD Department of Medicine University of Wisconsin School of Medicine and Public Health 3116 MFCB, 1685 Highland Avenue Madison, WI 53705 ***@****


To date, the precise mechanism of atrial fibrillation (AF) as a possible cause of reflux disease remains uncertain, although some possibilities can be postulated. Inflammation and vagal stimulation may have a key role linking these 2 common diseases. There is some evidence in the form of case reports and limited observational studies reporting that reflux disease, and more specifically esophagitis, can cause paroxysmal AF, and various mechanisms have been proposed. Some studies have demonstrated that acid suppressive therapy by proton pump inhibitors (PPIs) may help ameliorate symptoms associated with AF and also facilitate conversion to normal sinus rhythm in a subset of patients. Further prospective studies are needed to determine if a true causal mechanism exists between the two and assess whether the mechanism is dependent on a specific subtype of AF. In addition, the response of AF-related symptoms to PPI therapy and the potential for PPI therapy to reduce the development of AF merits further investigation."

Full article is available online:  http://onlinelibrary.wiley.com/doi/10.1002/clc.21969/pdf

Hope this helps in some way.  I have SVT, PAT ,GERD and IBS, and between ablations, SVT and chest pain have been in and out of hospital a few times over the past couple of years.  Like many of you, I have (sometimes) relief with burping and feel that my symptoms are worse when I have worse stomach/gut symptoms.  I have also had difficulty conveying this to the various health professionals I have encountered.  After looking around at the net, it seems that there is very little known about this possible correlation thus far, but hopefully this is beginning to change.

Good Luck

[tom_h]

I had SVT in 1957 at 6 years old.  Back then, I too was told to gulp ice water to slow it.  It might have aided conversion, but it didn't work by itself, ever.  I went unmedicated from about 10 to my early 50's using Valsalva to slow my heart.  Doctors showed me how to perform this common technique when I was first hospitalized with it.

[Rache101]

Hi - yes, have SVTs and hiatus hernia. All heart  symptoms disappeared after they put a camera tube down - doc was quite firm with pushing the tube down and I think he pushed stomach back into place below diaphragm. Was OK for nearly a year.

Now doc is recommending surgical fixing of hernia - will see what happens. He thinks this may fix heart because there's a reflex between gullet and the heart which is why drinking very cold iced water can help. Or sucking an icecube. I asked him why no one has suggested this before and he says it's old school - docs used to be taught it, now they just give out pills.

Hope helpful.

Rachel

[MichelleP_3811]

I had it ablated 1 year ago beginning of September.  I haven't had an episode since though I still get the pvcs and pacs.  You will likely not be rid of those  unfortunately because they are a whole different animal.  For me I was never afraid of the svt I guess because I grew up with it.  I actually always thought I was hyperventilating and my heart was beating fast because of my lungs as opposed to having a hard time breathing because my heart was beating too fast.  The episodes were always very short lived up until the last 5 years.  Then I had an episode that lasted 8 hours and realized that something more might be going on.  And so I eventually wound up getting the ablation.  At the time I was having them at least biweekly so I was pretty active and easy to provoke.   To be honest, besides for the part when they burned the spot, I kind of thought the ablation itself was neat, though going in I was absolutely terrified.  My doctor was a hoot jumping up and down getting all excited about it all.  I think maybe I am weird.  I have had 2 full on abdominal surgeries and those were a nightmare compared to the ablation, which is probably why I really didn't see it as a big deal.  Good news is you know what to expect so the suspense won't be as bad.  Anyways, let me know when yours is scheduled and I will keep you in my thoughts.

[thedude1973]

Thanks, just turned 39.  and yes, I am hoping just regulard avnrt.  maybe have better luck this time.  it only shows up 1-4 times a year (most years about twice) but when they show up, it leaves a nice lasting fear of it.  Did you get yours ablated successfully?

[MichelleP_3811]

I am not clear what your age is.  I had avnrt my whole life but it only got really active after I reached my mid thirties.  Before then it can be a little hard to capture due to its rare occurrences.  When I had mine captured at age 44 the rate was 230bpm.  I think if you are quite a bit younger than that still then it may not be unheard of for the beat to go to close to 300.  And if they weren't actually able to induce an episode when you went in the first time it is very possible they didn't ablate the correct spot.  The good news is your holter should have caught exactly what it was.  Did you get word from your doctor about what they saw?  It actually would be good if it was still unresolved avnrt because that really, if they can induce an episode, is a much easier fix then afib and it has a very high success rate so long as the extra pathway isn't in a bad spot.  Well good luck with the second ablation.  Maybe being a bit older will help the doctors in getting your svt triggered, mapped and successfully ablated so you can move forward with your career.  Good luck keep us posted on how it all goes.  

[thedude1973]

Was suspected AV reentry.  never caught it on tape, so they did an ep study.  Caught some echos and ablated the suspected pathway.  Thought it was a success.  had a few suspected in 2011, had a 30 day and what showed up a few times were just a sinus tach... there was one that didnt get recorded due to loose wires that they listed as svt or sinus tach.. doc wrote it off as sinus.  So with this one in october, it caught the big one.  I'm nervous, to see what it is.  and yea, the 300 is a bit high.  so could be afib.  Used to drink and party when i was younger, but really cut it out when the pvcs started.  occasionally have a few but no more  than 3 or 4 times a year.  
Yea, planning on a second ablation...  nervous about it.  I hate this stuff.  

[MichelleP_3811]

I cant speak to any tears but do know that acid reflux does have an affect on ectopic beats.  I have days where I get pvcs and pacs all day long but on the days I don't I usually will still get them after I eat.  I probably should check into my diet but I do my best to eat healthy so I just live with the ectopic beats.  What type of svt did you have corrected in 2009?  Afib?  With rates close to 300 it sounds a bit like afib to me.  It is not uncommon for very athletic people, especially men, to develop afib.  And alcohol can be a bit of a trigger as well if one is prone to it.  Unfortunately even after it has been fixed it can sometimes come back requiring a repeat ablation.  I am not sure what the health requirements are for the FAA license but you may need to get a repeat ablation to get your certificate.