DENVER (EGMN) – Hiatal hernia is associated with sharply increased risk of atrial fibrillation, according to a large Mayo Clinic study.

“The mechanism of the increased prevalence of atrial fibrillation in patients with hiatal hernia is not known but likely involves the direct mechanical effects of the hiatal hernia pressing on the left atrium or indirect effects through activation of the autonomic nervous system or inflammation, Dr. Komandoor Srivathsan said at the annual meeting of the Heart Rhythm Society.

“Of course, it would be nice to show that if you treat the hiatal hernia with modified fundoplication the atrial fibrillation rate goes down. We’re looking into that now in our database. We should have the answer in the next 6 months,” added Dr. Srivathsan of the Mayo Clinic, Rochester, Minnesota.

The study was undertaken after he and his coinvestigators formed an impression that a disproportionate number of patients at the clinic’s large-volume atrial ablation center had hiatal hernias on their preablation CT scans, echocardiography, or both. So the investigators used the Mayo Clinic’s electronic medical records system to identify the 111,429 adults diagnosed with hiatal hernia during 1976-2006. Among this group were 5,929 patients diagnosed with new-onset atrial fibrillation after they had already received a diagnosis of hiatal hernia.

For purposes of comparison, the investigators turned to published data on the Olmsted County and statewide Minnesota general populations. In this way, they determined that the prevalence of atrial fibrillation in men under age 55 with hiatal hernia was 13-fold greater than in the age-matched general population. Among women under age 55, atrial fibrillation was 15-fold more likely if they had a hiatal hernia.

Moreover, the prevalence of atrial fibrillation in men with hiatal hernia remained several-fold greater than in men without this abdominal defect up until about age 80. Among women, this remained the case even beyond age 80, Dr. Srivathsan continued.

Patients with hiatal hernia and atrial fibrillation were a mean of 73 years old at the time of their dual diagnosis, compared with 61 years for those with either diagnosis alone. The dual-diagnosis group had significantly more hypertension, diabetes, hyperlipidemia, coronary artery disease, heart failure, and sleep apnea.

The dual-diagnosis group had markedly worse long-term outcomes than did the general population.

“One you have the combination, it seems to be a strong predictor of congestive heart failure,” the cardiologist observed.

Indeed, within 10 years of receiving the dual diagnosis, roughly half of patients had heart failure, compared with about one-tenth of the age-matched general population of Olmsted County. And the all-cause mortality rate within 10 years following dual diagnosis was significantly greater than in the general Minnesota population.

One audience member observed that some patients with hiatal hernia never receive the formal diagnosis, but instead are told they have reflux and put on a histamine-2 receptor blocker. He asked whether the use of these drugs in such patients may lessen their risk of developing atrial fibrillation.

Dr. Srivathsan replied that he and his coworkers are examining that in a subgroup analysis. They are also interested in learning whether atrial fibrillation is more severe in patients with hiatal hernia.

He reported no conflicts of interest.

Copyright (c) 2009 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

丹佛(EGMN)——根据梅奥医院的一项大型研究，食管裂孔疝与心房颤动风险显著增加有关。

 

Komandoor Srivathsan 博士在美国心律学会年会上说：“食管裂孔疝病人心房颤动患病率增加的机制尚不清楚，但可能涉及食管裂孔疝对左心房的压迫造成的直接机械效应，或通过自主神经激活或炎症的间接效应。”

 

Srivathsan 博士来自明尼苏达州罗切斯特的梅奥医院，他补充道：“当然，如果进行改良胃底折叠术治疗食管裂孔疝，从而降低心房颤动的患病率就好了。我们正在对我们现有的数据库进行调查，并将在6个月内得到答案。”

 

他和同事们发现，临床上有大量心房消融中心的病人，在其消融前的CT扫描或（和）超声心动图显示存在食管裂孔疝，此后，他们开始着手这项研究。研究人员利用梅奥医院的电子医学病历系统找出了1976~2006年期间111,429例诊断为食管裂孔疝的病人，这些病人中，5,929例在已经诊断食管裂孔疝后诊断为新发房颤。

 

为了进行对照，研究人员对比了奥姆斯特德郡和明尼苏达州全州一般人群的公开数据。他们发现年龄<55岁的男性食管裂孔疝病人，其心房颤动的患病率是同龄一般人群的13倍。在<55岁的女性中，如果罹患食管裂孔疝，其房颤患病率则是一般人群的15倍。

 

Srivathsan博士补充说，直至80岁左右，男性食管裂孔疝病人心房颤动的患病率始终比没有该病的男性高数倍。在女性中，这种趋势甚至持续到80岁以上。

 

确诊为食管裂孔疝和心房颤动双重诊断的病人的平均年龄为73岁，与之相比，确诊为其中一种疾病时的平均年龄为61岁。双重诊断组的病人更常患有高血压、糖尿病、高脂血症、冠状动脉疾病、心衰和睡眠呼吸暂停。

 

与一般人群相比，双重诊断组病人的长期转归显著较差。

 

心脏病学家注意到：“同时确诊这两种疾病是充血性心力衰竭的强预测因子。”

 

的确，十年内双重诊断组的大约一半的病人发生心衰，而奥姆斯特德郡同龄的一般人群，发生心衰的人只有1/10。并且，10年内双重诊断组所有原因的死亡率显著高于明尼苏达州的一般人群。

 

一位听众观察到，一些食管裂孔疝的病人从未得到正式诊断，但被告知患有食管反流而服用H2受体阻滞剂。他问是否可对这些病人使用这些药物以减少发生房颤的风险。

 

Srivathsan博士回答说，他和他的同事正在进行亚组分析。他们也有兴趣研究食管裂孔疝病人的房颤是否更严重。

 

他申明此项研究没有利益冲突。

 

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