The Association Between Gastroesophageal Reflux Disease and Atrial Fibrillation: A Systematic Review and Meta-Analysis

TL;DR

This study finds a significant link between gastroesophageal reflux disease and atrial fibrillation, suggesting GERD management may help reduce AF risk.

Contribution

The study provides genetic evidence and a potential causal mechanism linking GERD and AF through a systematic review and meta-analysis.

Findings

GERD is associated with a 27% increased risk of atrial fibrillation (RR: 1.27, 95% CI: 1.15-1.40).

Mendelian randomization studies support a potential causal relationship between GERD and AF.

Inflammatory pathways from the esophagus to the left atrium are proposed as a mechanism.

Abstract

The relationship between gastroesophageal reflux disease (GERD) and atrial fibrillation (AF) has been increasingly recognized, but its nature and strength remain unclear. We conducted a systematic review and meta-analysis of studies from January 2010 to November 2024 using PubMed, Excerpta Medica Database (EMBASE), and Web of Science databases. Seven studies were included: three cohort studies, two Mendelian randomization studies, one case-control study, and one cross-sectional study. Meta-analysis revealed that GERD was associated with a significantly increased risk of AF (RR: 1.27, 95% CI: 1.15-1.40). This association remained robust in sensitivity analyses. The two Mendelian randomization studies provided genetic evidence supporting a potential causal relationship. The proposed mechanism involves inflammatory pathways extending from the esophagus to the left atrium. The analysis was constrained by the small number of studies, methodological heterogeneity (I-Square: 81%), and limited ability to perform subgroup analyses. The findings suggest that GERD patients may benefit from AF screening, and GERD management could potentially modify AF risk. Future research should focus on prospective studies examining the impact of GERD treatment on AF prevention and progression, as well as identifying high-risk subgroups who might benefit most from targeted interventions.

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