In a recent study published in Clinical and Translational Gastroenterology, researchers evaluated the correlation between the incidence of GERD and the risk of short-term repeat radiofrequency ablation in patients with atrial fibrillation (AF) and the impact of PPI therapy in altering this risk.
The authors wrote, “Gastroesophageal reflux disease (GERD) has been associated with increased incidence/recurrence of atrial fibrillation (AF). However, the impact of GERD and proton pump inhibitor (PPI) therapy on outcomes of AF catheter ablation remains unclear.”
This retrospective cohort study involved patients with paroxysmal/persistent AF who underwent initial ablation from January 2011 to September 2015. Endoscopic findings, objective reflux testing, or clinical symptoms were the criteria to define GERD. Time-to-event analysis with censoring at the last clinic follow-up within 1 year assessed the correlation between GERD/PPI use and time to repeat ablation.
The authors wrote, “All patients received prophylactic proton pump inhibitor (PPI) therapy following catheter ablation, most commonly omeprazole 40 mg twice daily for 12 weeks, as per standard institutional protocol to prevent ablation-related esophageal injury.”
Patients were then followed for 1 year after the initial catheter ablation event. All patients with GERD were then allocated to one of two groups: 1) an untreated group, defined as those who discontinued PPI therapy following the standard 12-week prophylactic period after ablation, versus 2) a treated group, defined as those who remained on PPI therapy of any regimen after 12 weeks during the follow-up period.
The study cohort included 348 patients. The results revealed that patients with GERD (n = 80) had a higher 1-year repeat ablation rate compared with those with no GERD (25% vs. 11.3%, P = .0034). Moreover, when patients were categorized by use of PPI, patients with untreated GERD (37.5%) were more inclined to warrant repeat ablation compared with reflux-free (11.3%, P = .0003) and treated GERD (16.7%, P = .035) subjects.
The multivariable Cox regression analyses revealed that GERD was an independent risk factor of repeat ablation (hazard ratio [HR], 3.30; CI 1.79-6.08, P = .0001). In particular, untreated GERD was linked to an earlier need for repeat ablation compared to individuals without GERD (with a HR of 4.02; CI 1.62-12.05; P = .0013); however, there was no significant variance in repeat ablation risk between those who were reflux-free and those with PPI-treated GERD.
Based on their findings, the authors concluded that within 1 year of treatment, GERD was an independent predictor of the risk of repeat catheter ablation for AF, even after controlling for major cardiovascular risk factors and comorbidities. In addition, PPI therapy may temper this risk, such that repeat ablation-free survival for patients with treated GERD was comparable with that of reflux-free patients.
The authors wrote, “These findings support a role for GERD as a potentially modifiable risk factor in AF development, recurrence, and treatment outcome. Assessment for and aggressive therapy of GERD should be considered in the routine management of recurrent and refractory AF.”
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Published August 7, 2024