"Researcher:" Proton pump inhibitors prescribed by EPs following ablations

Can "Researcher" or those who have had ablations explain why Dr. Natale and probably other EPs routinely prescribe the use of proton-pump inhibitors following ablations?

Carol

To guard from acid reflux causing or exacerbating Esophageal Injury after Radiofrequency Ablation for Atrial Fibrillation.

My EP prescribed Nexium 1 week before and 2 weeks after ablation. I think McHale is right, to help prevent Esophageal injury after RF ablation. In my case it didn't work. I had to get a new prescription after mine ran out, because I was still experiencing heartburn/acid reflux. I am now over 5 months post ablation and have still not been able to wean off Nexium, because of continued heartburn. I have not had any further AFIB episodes, however.

Jim

Carol

Dr. Natale didn't prescribe PPI when I had the ablation 7 months ago.

BillC

Taking PPI came up because of the recent experience of Tom P where his EP found some unusual anatomy and had to ablate adjacent to his esophagus and PPI was prescribed as a precaution. The odds of AEF leading to death is very low, something like .01% or 1 out of 10000 ablations from the Cappato AF survery. The Germans found in their research that 10-20% of ablation patients experience esophageal temperatures beyond what the EP is comfortable with. So even among those 10-20%, none ended up with full blown AEF. Most procedures now include a temperature probe and esophagus imaging, and PPI to help avert problems. PPI adds an extra margin of safety. There are only a handful of deaths reported nowadays on an annual basis. However, I think the most severe cases are not going to be rescued. For example, a majority the 2011 AEF cases had to do with devices using thick sheaths that are stiff and probably resulted from too much force on the heart tissue..

Jim,

Since you still have acid reflux/heartburn five months after your ablation, doesn't that suggest that the ablation might have actually caused reflux? Did you have reflux before your ablation?

I, too, have struggled with acid reflux since my ablation in Sept. 2008 and am thankful to the EP that I am also afib free.

Carol

Carol, I do think that my ablation probably caused my acid reflux, since I never had it prior to the ablation. However, I am just happy to be AFIB free. My EP seemed to think it was caused by the Pradaxa, but I had been taking it for over 3 months prior to the ablation without problem. I have found that Nexium controls my heartburn, but don't want to take it long term because of it's calcium robbing effects.

Jim

What is "AEF"?

yes I was put on PPI for 3 weeks following ablation of 8/21......I took it for 2 weeks and threw it away as I noticed nothing in the way of acid reflux or swallowing problems......my EP said that some of my PVI ablation was very close to my esophagus, closer than average!

Tom P

Jim,

May I ask what you do to try to minimize or control your acid reflux?

It is important, as I'm sure you know, because acid reflux irritates the esophagus, and that in turn can irritate the vagus nerve that lies close to the esophagus, and that can trigger afib. (So, we go from a gastroenterological problem into a cardiac problem)

Carol

Carol - If you can visualize that the heart rests on the esophagus... (in the chest wall, all the organs are packed in tightly together).. and the back wall of the heart rests directly on the esophagus. When it's necessary to do burns on the back wall of the heart, the heart tissue heats up and can cause some irritation where that tissue rests on the esophageal tissue. This is also the area where the burn can go through the heart wall and into the esophagus causing the dreaded 'esophageal fistula.' Newer techniques and equipment plus the skill of highly experienced EPs virtually eliminate the concern over the fistuala complication.

When I attended the AF Summit years ago, time was spent on the need for extreme caution in this area to control the energy/heat produced because the warning was... the tissue keeps on heating even after the energy source is off and if you don't stop soon enough, then the potential for a burn through the wall is high. It makes sense that these close proximity areas might need to be protected from gastric irritation and prescribing a PPI to lessen the risk of irritation and discomfort would make sense just in case a person has reflux issues when that tissue is highly irritated.

Just consider when you burn your hand severely... it's sensitive to any irritation for quite some time after the trauma...and with ablations, hearts have definitely received trauma.

Jackie

.

Gehauser, Sorry I wasn't clear. AEF stands for Atrio-esophageal-fistula. That is when the catheter burns both the heart tissue and the esophagus to the extent that holes form and introduction of air and other fluids into the circulation system occur. It is usually fatal and can take several days to develop. It is probably caused by too much force on the catheter while in ablation mode and fortunately very rare.

This may or may not be of help, but if any of you with reflux are on probiotics, especially Align, that could be your problem.

Carol, other than restrict food or beverages that irritate my esophagus, not much. I have tried Nexium, Zantac, Tums and chewing gum to try to reduce the acid. Nexium works the best for me, but is not that long lasting. If it does not go away soon, I will visit a gastroenterologist and have some tests taken, although I am tested out right now. I don't really want to have a camera stuck down my throat again (TEE).

Jim

Ken, what is the significance of using probiotics if you have acid reflux? I am very curious about this as I too have had increase esophageal problems since my ablation nearly 6 months ago, and have had to take Prilosec. I have also been taking probiotics for about 4 months

DavidS - one consideration might be that the probiotic also contains the FOS ingredient that contributes 'food' or sugar to help sustain the bacteria. However, when people have SIBO... small-intestine bacterial overgrowth... the use of any added FOS or like ingredients such as inulin are contraindicated since that cause considerable gas and bloating.

Commercial probiotics such as the Align mentioned are mostly inferior 'me-too' products that contain a lot of added ingredients. True probiotics are just that...nothing addded and are of sufficient quantity of active cultures ...at least 5 billion but preferably closer to 25 billion are the types that actually make a difference in intestinal health. These should do nothing to contribute to reflux.

Reflux is typically caused by the lack of stomach acid and that causes the inability to breakdown food particles..especially proteins and fats ... and the result is gas, bloating, pain and reflux into the esophagus. There are many previoius posts discussing digestion, reflux, lack of stomach acid and the influence on AF. Many people have found by adding digestive enzymes with meals, they not only improve digestion and reflux, but also dramatically control PACs and AF.

Jackie

Jim,

In my experience, gastroenterologists put patients under short acting conscious sedation, so you don't experience the tube exploring your gut.

There is really nothing to it.

Also see Jackie's post below about the theory that two little stomach acid is the culprit and that therefore enzyme supplements are beneficial. Generally speaking gastroenterologists think too much stomach acid is the problem and therefore prescribe acid blocking or reducing drugs.

Carol

I have not had an ablation, but I have ended my acid reflux and the indigestion that triggered many afib episodes by getting a food sensitivity test and by stopping eating foods that I have become intolerant too. My test was from Alcat, but I believe there are other labs that provide this service. I honestly do not see how anyone with ill health can regain their health without finding out what is irritating you. There are many food products that our bodies have not evolved to handle well. Genetically modified grains are causing us to eat many times the amount of gluten. Our ancestors ate many different foods when they were seasonally available - now, in very recent terms, we are consuming foods 12 months a year and our bodies are reacting and developing intolerances to them.

I may be in the category of a person with a little knowledge sounding like I know everything, or on the other hand I may know something that is so plain and simple that everyone is missing it. Very simply, what I have discovered is that if you stop eating foods that are bothering your stomach you will feel better - in every aspect of your life. And when you stop irritating your stomach, your Vagus nerve will stop being over stimulated. In my case, my Sinus Bradycardia (low heart rate) normalized, and the afib beast stopped visiting me in the middle of the night.

I don't believe you can ever figure out what foods are doing it to you on your own. We put too many different things in our body every day to be able to isolate which foods are causing the problem, and so you get into a guessing game.

The ablation may or may not be causing your reflux, I have no idea. But it sounds pretty scary to me and makes me want to redouble my efforts to beat this thing without a proceedure.

We are very fortunate to have cold hard science available now to determine what the causes of stomach problems are. Unfortunatly most doctors don't have a clue about it, and you have to find an alternative practioner to provide you with the test, or I think you can order it on your own, but then you need to find a clinic that can draw blood for the test.

I am not sure if I would have lived very long with the constant nights awake with a roiling gut and afib. In the 4 years since my first incident I missed at least 500 nights of sleep. I stumbled across the test quite by accident and can say without hesitation that it improved my quality of life many times over.

Ron B - good for you... that's the most effective way to begin the road back to health. It makes no sense to take drugs etc and continue consuming offending substances. In the world of advanced medicine often called Functional Medicine, the rule for every new patient is to evaluate and then fix the gut first...and that includes food sensitivity testing, GI evaluations for dysbiosis, eliminating all of the negative influences indicated by testing, and then begin the restorative process by repairing the gut tissue and putting back the important friendly bowel flora and using digestive enzymes when needed. It just makes good sense not to keep insulting the body.

Jackie