Esophageal acid exposure and altered neurocardiac function in gerd patients with idiopathic arrhythmias

Background: Esophageal sensory stimuli may affect neurocardiac function, however the relationship between esophageal acid reflux and cardiac arrhytmias is not clear, Aim: To evaluate whether gastroesophageal reflux could alter cardiac rhythm in patients with idiopathic supraventncular arrhythmias and symptoms of GERD. Subjects and methods: 21 patients (ll males, aged 20-69 years), with idiopathic supraventricular arrhythmias and GERD symptoms, underwent simultaneous 24-hours pH-metry and ECG monitonng. Power spectrum analysis of heart rate variability (PSHRV), with its low frequency (LF, influenced by sympathetic modulation) and high frequency (HF, influenced by vagal modulation) components, was obtained and LF/HF ratio calculated. Total time with esophageal pH<4 and mean of pH, were considered during pH-monitonng, and compared with PSHRV data. Results: In 1'0 out of 21 patients (47%), a significant correlation between mean esophageal pH and LF/HF ratio was observed (p<0.05). In 5 of these patients the pH decrease was positively correlated with a decreased ratio (r = 0.51 +- 0.08), which was depending on the HF component increase, in the remaining five cases, a negative correlation (r-0 52 +_ 0 12), with an increase of ratio depending on the LF increase was conversely observed. Furthermore, time with esophageal pH<4 was slgnificandy lower in the 10 acid responsive patients than in non-responsive subjects (2.6-+07 % of time with pH<4 vs 7.4+-2.1; p<0.05) Conclusions: This study has identified a subgroup of patients wnh idiopathic supraventricular arrhythmias and cardiac autonomic reflexes elicited by the acid stimulus in esophagus, The presence o[ a lower esophageal acid exposure suggests an increased acid sensitivity in this subset of patients