PPI's and arrhythmia

Another awareness alert reminder in the realm of “where there’s smoke, there’s fire” potential. Note this from 2010.… might be interesting to do a survey here of members who have used PPIs and found an increase in arrhythmia.
We certainly know that increased intracellular calcium levels with low IC magnesium is not good.

Proton Pump Inhibitors Associated With Focal Arrhythmias
Tissue studies have demonstrated that H+/K+-ATPase is expressed in myocardium,5–7 and both animal and human tissue studies have shown that PPIs have electrophysiologic effects,5–9 potentially by increasing intracellular calcium concentrations.8

Aberrations in calcium handling may play an important role in arrhythmias that arise due to triggered activity or enhanced automaticity.10–14 The most common arrhythmias attributed to increased automaticity or triggered activity are focal atrial tachycardia (AT) and right ventricular outflow tract (RVOT) automaticity. We hypothesized that PPI use would be associated with arrhythmias attributed to increased automaticity or triggered activity.

We found that PPI use was significantly more common in patients with focal tachyarrhythmias than controls. After adjusting for potential confounders, PPI use was associated with a nearly fourfold greater odds of focal tachyarrhythmia. This finding was consistent with both the AT and the RVOT automaticity groups alone exhibiting a greater proportion of PPI use than the control group. After adjusting for potential confounders, PPI use was associated with a statistically significant fivefold greater odds of focal AT.
[www.innovationsincrm.com]

[www.ncbi.nlm.nih.gov]


Counterpoint:
2015 [www.ncbi.nlm.nih.gov]

If you do a search on PPIs and arrhythmia, there are numerous studies examining the topic.

Jackie

Hi Jackie,

Noted, but - as is the case in so many similar scenarios - is it not equally likely (or more likely) that the reasons WHY folk are taking PPIs are involved with precipitating arrhythmias more than are the PPIs themselves per se?

Looking forward to your upcoming piece on mitochondria and what we can do to try and look after them better!

Kind regards, Mike

Quote
mwcf
Hi Jackie,

Noted, but - as is the case in so many similar scenarios - is it not equally likely (or more likely) that the reasons WHY folk are taking PPIs are involved with precipitating arrhythmias more than are the PPIs themselves per se?

Looking forward to your upcoming piece on mitochondria and what we can do to try and look after them better!

Kind regards, Mike

This is a very good point. It could be something like a hiatal hernia pushing against the heart or vagus nerve. Also they're talking about not being able to absorb magnesium, potassium calcium etc. While I'm sure thats true when I've had my ablations, my blood tests were always normal for those two things and I've been on PPI's for 30 years. (granted the tests are only serum)

I've been taking a PPI for quite a few years now. I wish I could recall if when I started taking it coincided with an increase in Afib frequency, but my best recollection is that the 2 probably coincided. I would really, really like to stop taking the PPI, and was told it would be fine to stop by my PCP. But I also know that GERD/reflux can burn the esophagus, and that esophageal cancer is a horrible death.

So many things in life are a tradeoff. Is there a recommended approach to stopping PPI's?



Edited 1 time(s). Last edit at 05/16/2018 02:16PM by AB Page.

Esophageal cancer is less of a concern than esophageal ulcer. Cancer is slow to develop and if you get in upper endoscopy the precursor will be seen. Ulcers are worse. If they really bleed while you’re sleeping you can choke on congealed blood. In either case, I’d just ask my GP for a referral to a GI doc and make a plan for stopping the PPIs with careful observation. In that context things should be just fine.

Thanks Wolfpack, I'll look into that.

I think the problem with stopping PPI's is that you'll likely be left in the condition that you were when you needed to take PPI's. In my case I was 25 years old and I had rediculous heartburn. I would go through a big bottle of tums every few days and would never be caught anywhere with them. People would make fun of me because I was always eating tums. Then PPI's came along and I thought I won the lottery. lol..

I've tried getting off them a few times and its a joke. Just puking acid every five minutes. Then I end up eating a ton of tums just like I did when I was 25.
I really think if you have gerd that bad and have proper insurance, it would be best to try and get some surgery either for LES or for a hiatal. Whatever it is thats causing it. If I were to do it again, I would have gotten a surgery.
If its a mechanical problem, I don't think it can be solved without a mechanical solution although there are a few who have been able to get off PPI's successfully. I assume their gerd wasn't insane.
Another alternative is to try the other anti acid meds that aren't PPI's. I personally had no luck with that.

It really takes time to "recover" from chronic PPI use. I know, I did it. It sucks. The rebound effect is vicious.

You could try DGL (licorice root) instead of Tums, which are going to overload you with calcium. Make sure it's the DGL and not plain licorice root. Plain licorice root can cause "false" aldosteronism and dump potassium. The key here is the darn near unspellable and unpronouncable word glycyrrhizin. You want de-glycyrrhizinated licorice root.

Quote
wolfpack
It really takes time to "recover" from chronic PPI use. I know, I did it. It sucks. The rebound effect is vicious.

You could try DGL (licorice root) instead of Tums, which are going to overload you with calcium. Make sure it's the DGL and not plain licorice root. Plain licorice root can cause "false" aldosteronism and dump potassium. The key here is the darn near unspellable and unpronouncable word glycyrrhizin. You want de-glycyrrhizinated licorice root.

Good info.. Were you diagnosed with a faulty LES or hiatal? How often do you get reflux now?

No diagnosis of hernia. I had an esophageal ulcer in early 2014 that was caught after a routing physical showed fecal occult blood and low iron in my blood. Subsequent endoscopy found the ulcer. I was on 40mg BID pantoprazole for 6 months until a recheck showed that it had healed. Then I dropped to 20mg BID and continued that until just last year when I decided I did not want to continue long term use. I tried a few times to stop and the rebound effect (mostly burping really badly while running with nasty food tastes coming back up) made me go back to the PPIs. At last I just suffered through it until it stopped. I supplement B12 (methylcobalamin) and zinc 50 mg daily. I haven't had bad reflux since.