The Impact of Gastroesophageal Reflux Disease and Proton Pump Inhibitor Use on the Risk of Repeat Catheter Ablation for Atrial Fibrillation

Jennifer X Cai; Miguel Algara; Wai-Kit Lo; Sunil Kapur; Walter W Chan

doi:10.14309/ctg.0000000000000717

The Impact of Gastroesophageal Reflux Disease and Proton Pump Inhibitor Use on the Risk of Repeat Catheter Ablation for Atrial Fibrillation

Clin Transl Gastroenterol. 2024 May 16. doi: 10.14309/ctg.0000000000000717. Online ahead of print.

Authors

Jennifer X Cai^{1

2

3}, Miguel Algara^{2

3}, Wai-Kit Lo^{1

2

3}, Sunil Kapur^{2

4

3}, Walter W Chan^{1

2

3}

Affiliations

¹ Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA, United States.
² Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States.
³ Harvard Medical School, Boston, MA, United States.
⁴ Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, United States.

PMID: 38752627
DOI: 10.14309/ctg.0000000000000717

Abstract

Background: 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. We aimed to assess the association between the presence of GERD and risk of repeat AF ablation, stratified by PPI therapy.

Methods: A retrospective cohort study was conducted on paroxysmal/persistent AF patients undergoing initial ablation in 1/2011-9/2015. GERD was defined by endoscopic findings, objective reflux testing, or clinical symptoms. The association between GERD/PPI use and time to repeat ablation was evaluated by time-to-event analysis with censoring at last clinic follow-up within one year.

Results: 381 subjects were included. GERD patients (n=80) had a higher one-year repeat ablation rate compared to no GERD (25% vs 11.3%, p=0.0034). Stratifying by PPI use, untreated GERD patients (37.5%) more likely needed repeat ablation compared to reflux-free (11.3%, p=0.0003) and treated GERD (16.7%, p=0.035) subjects. On multivariable Cox regression analyses, GERD was an independent risk factor for repeat ablation (HR 3.30, CI:1.79-6.08, p=0.0001). Specifically, untreated GERD was associated with earlier repeat ablation compared to those with no GERD (HR 4.02, CI:1.62-12.05, p=0.0013). However, no significant difference in repeat ablation risk was noted between reflux-free and PPI-treated GERD groups.

Conclusion: GERD was an independent predictor for risk of repeat AF ablation within one year, even after controlling for major cardiovascular comorbidities and confounders. PPI therapy modulated this risk, as repeat ablation-free survival for PPI-treated GERD was non-inferior to reflux-free patients.