Clinical significance of heart rhythm variability in patients with gastroesophageal reflux disease

Abstract

Cardiac manifestations of gastroesophageal reflux disease (GERD) including retrosternal pain and cardiac rhythm disorders were often mentioned in early publications. However, classification of GERD adopted at the 2005 Montreal congress does not include such conditions. Non-coronarogenic pain in the thoracic cage is recognized to be a typical esophageal syndrome while the reflex spasm of coronary arteries and cardiac rhythm disorders associated with GERD should be regarded as manifestations of comorbidity of GERD and cardiovascular diseases. Arrhythmias occur in 30% of patients with GERD, but relevant therapeutic and preventive modalities are poorly developed. Nor are there reliable predictors of arrhythmias. An important role in their pathogenesis in patients with GERD is played bydisbalance of sympathetic and parasympathetic components of vegetative nervous system (VNS). One of the approaches to studying this issue is the analysis of heart rhythm variability (HRV). We consider basic principles of clinical interpretation of the results of HRV research that allow to evaluate the state of VNS and interaction of its components. Analysis of recent publications gives evidence that many HRV parameters depend not only on the balance between components of VNS as was believed by earlier authors (for the lack of their reciprocal relationship) but also on the activity of these components. Other modulating factors include the heart rate, respiratory pattern, intrathoracic pressure, and diastolic atrial extension. We report the results of HRV assessment in patients with GERD that illustrate heart rhythm rigidity and predominant disorders of activity of the parasympathetic component of VNS especially well apparent in patients with erosive reflux esophagitis. However, other authors demonstrate oppositely directed changes and the involvement of the sympathetic component. A possible cause of this discrepancy is factors other than VNS influencing HRV. It is concluded that analysis of HRV can be used to develop a method for the prevention of GERD-associated arrhythmia. The diagnostic value of such method is limited and requires new algorithms for data interpretation taking account of their multifactorial origin.