Symptoms of gastroesophageal reflux disease predicts low voltage zones in the posteroinferior left atrium in patients with persistent atrial fibrillation

Abstract

BackgroundThe presence of low voltage zones (LVZs) in the left atrium (LA) is associated with the recurrence of atrial fibrillation (AF) following pulmonary vein isolation. Numerous studies have posited a link between gastroesophageal reflux disease (GERD) and AF, attributing this relationship to the anatomical proximity of the esophagus to the posteroinferior wall of the LA. ObjectiveThe objective of this study was to investigate if GERD can predict the presence of LVZs in the posteroinferior wall of the LA. MethodsFive hundred and fifty-one patients with persistent AF, scheduled for their first AF ablation procedure, were prospectively enrolled. Voltage maps were collected using a multipolar catheter, and LVZs were defined as areas measuring ≥3 cm2 with a peak-to-peak bipolar voltage of <0.5 mV. Information on GERD symptoms was gathered from the participants through a self-administered questionnaire. ResultsLongstanding persistent AF was present in 22.3% of the total cohort. GERD was present in 29% of the patients and LVZs in the posteroinferior wall in 12.7%. In the multivariable analysis, patients with GERD were found to have more than twice the odds (Odds Ratio: 2.26, 95% Confidence Interval: 1.24-4.13, P=0.008) of exhibiting LVZs in the posteroinferior wall of the LA compared to patients without GERD. GERD was not associated with LVZs in any other region of the LA. ConclusionGERD was found to be independently associated with LVZs in the posteroinferior LA. This association may be attributable to inflammation and may partly explain the link between GERD and AF.