Here is my story.
About 8 years ago I began to notice the first indications that my heart rhythm was
showing signs of becoming abnormal. I am presently 38 years old, male and in otherwise
perfect health. I have no family history of heart disease and have always led an active,
healthy lifestyle. Aerobic activities such as skiing, running (including marathons),
kayaking (raced at 5 nationals), mountain climbing etc. have pretty much dominated my
life. The arrhythmia was first documented when I visited my family doctor who hooked me up
to heart monitor and noticed the supraventricular tachycardia (SVT). Some peculiar
findings were that the abnormal rhythm was usually initiated by the action of swallowing.
I was told not to worry about it and that it was something not that unusual (sound
familiar?). It generally intensified over the next few months, eventually becoming the
focus of my life. The uncertainty of what was happening created a lot of anxiety. The idea
of exercise was becoming almost impossible. After about 5 months of this it went away
completely for about 2 years. During this time I resumed a completely normal lifestyle and
ran about 50 - 60 kilometers per week. Everything was great until suddenly, for no
apparent reason, it began to creep back into my life again.
I had a variety of cardiac tests done (ECG, echocardiogram, blood tests, etc.) that all
proved negative. Well, things continued that way for 5 or 6 anxious months. The
cardiologists again said not to worry. The fact that the heart beat would be normal until
I swallowed seemed to puzzle the doctors. None (including a well known
electrophysiologist) had ever heard of that correlation. Then again it went away for about
a year this time. When it returned, a year later, I was becoming very frustrated and
nervous. Basically my normal lifestyle went on hold while this was affecting me. I would
go for a run with a heart rate monitor and watch my pulse beat happily along at 140 bpm.
If I didn't swallow the beat would remain normal. As soon as I swallowed the rate would
jump to 230 bpm instantly and then recover to 140 a few seconds later.
Unfortunately I suffered a prolonged occurrence (14 hours) of atrial fibrillation before
meds converted back to normal sinus rhythm. The cardiologists were wondering if I had an
accessory pathway and suggested an electrophysiology study. I was willing to do anything
so I had the study done. I was put on heart meds to control the rhythm. The whole time I
was on them (only a few months) I was sure something else was causing this problem. My
exact words to my family GP were "We are missing something here". It sounds
funny but after pushing my heart all my life and it serving me faithfully, I knew the
problem rested somewhere else in my system.
The electrophysiology study proved negative. Unfortunately the irregularity of the beat,
including the swallowing trigger, had gone dormant prior to the EP study. They told me my
heart mapped out perfectly. They listed all the possible reasons to explain my problem,
(which they called "lone afib")none of which were even remotely close to
describing my situation. So I said, "Why do I have this?" Their response was
"We don't know enough about this yet". "Great, but where does that leave
me?" Well, I was told to stay on the meds for the rest of my life. I was also told
that I may need a pacemaker sometime. NO WAY! So I began my search.
I spent days/weeks/months on the net exploring for any clues. I visited a homeopathic
specialist who noticed problems with my digestive system. I was also told my liver had
some trouble. All pretty unscientific but I pursued it anyway. I asked for an ultrasound
of the liver and it turned out to be fatty (again I don't drink, smoke or eat poorly). The
doctors couldn't explain this either. How many mysteries can one person have? Well it gets
better... I asked for a Barium swallow to get a look at my esophagus. The doctors didn't
want to do this test because I showed none of the typical symptoms of GERD. So I lied a
bit and they did it anyway. To everyone's surprise I had significant reflux up to the
In retrospect I did have lots of acute pains in my chest and back that I attributed to the
heart condition or the stress, but I never had trouble sleeping or any of the typical
heartburn symptoms. Actually I have always slept like a baby throughout all of this. Well
they acknowledged the reflux and put me on Pantoprazole and Propulsid to knock it down.
After a month of these meds ( I had no side effects) I was put on Pepcid 20 mg 2x day and
before long the heart problem began to disappear again. That was about a year ago.
During the past year my lifestyle has basically returned to normal. I still have yet to
resume my usually activity levels but I don't want to push it too soon. I have had some
troubles with the stomach, probably due to poor eating habits or work stress. When I
notice any hint of the rhythm problem returning I take some of the antacids and the
problem goes away. On one occassion while engaged in a full day of hiking and climbing I
suffered a short bout of afib lasting about 15 minutes. This caught me by complete
surprise because I had been feeling no indication of any rhythm problem at that point. The
afib actually occurred following a 60 minute, easy run with a light pack on my back. I
noticed soon into that run that the swallowing trigger was happening. I ignored it and
paid the price an hour later. I have noticed that the jarring action of running seems to
aggravate this problem. If I bike or swim I can get my heart rate up pretty high without
any trouble. If I run the bouncing seems to stir things up.
To this day no doctor has acknowledged that the connection between the heart rhythm and
the digestive tract is a real one (other than the known effect of some foods like
caffeine). I have had many people email me telling me of similar stories. A few doctors
have indicated some support for the idea of a possible causative relationship. I still
live with the fear of future rhythm problems. So what is causing all this - here is one
possible theory based on what I have experienced.
The heart is controlled by the autonomic nervous system which has two basic mechanisms.
Sympathetic nerves serve to stimulate or speed up the heart rate. Parasympathetic nerves
do the opposite, that is slow the heart rate. During the day
most of us are in a continuous sympathetic tone. At night the parasympathetic response
takes over. The Vagus nerve is a massive nerve that runs along the posterior part of the
esophagus. It has many functions including a parasympathetic effect on the SA node of
the heart (Pacemaker). I believe that chronic reflux has caused an irritation of
this nerve which, especially when I swallow , delivers an inappropriate parasympathetic
stimulus to the SA node. The sympathetics will win out, especially during exercise, but
the effect will result in a disruption to the normal sinus rhythm. At night the
parasympathetic tone is dominant so swallowing doesn't interfere with anything (hence I
sleep well). So why doesn't everyone with reflux have this problem???? Who knows, perhaps
I have a slightly different anatomical relationship with the vagus nerve and the
esophagus. As I reflect back on the many clues and pieces to this puzzle I can see that
more and more of this possibly relates to acid reflux.
Recently I had a gastroscopy done. Mild to moderate esophagitis was observed along with
the presence of significant amounts of bile in the stomach. This would suggest problems
with gastric motility. Perhaps the acid itself is not the problem but some other
mechanism. Could spasmodic peristalsis somehow act as the trigger? Could the bile itself
be responsible? I think the key to solving this mystery is isolating the trigger
mechanism with regards to why the mechanical action swallowing causes the interruption to
normal sinus rhythm.
I have probably left out many important parts to this puzzle but hopefully enough has been
given to round out my story. When I talk to others with classic GERD I can't say that I
have all the typical signs or symptoms. Actually if it were not for the heart beat problem
I would have never considered it. But the facts are that when I targeted the reflux the
heart problem did improve. I now eat properly and do all the typical GERD self-help
There are still many observations still unresolved such as:
1. The episodic nature of this problem. It has come and gone over the past 8 years.
2. Swallowing as the trigger mechanism (providing conscious control over when the beat is
3. Positive esophagitis and the presence of bile in the stomach.
4. Effects are enhanced by the jarring action of running. Smooth activity such as biking
does not seem to create the problem to the same extent.
5. Why my nights are relatively peaceful with no interruption of sleep. Basically normal
6. Gastric distress for several weeks prior to the onset of the arrhythmia.
7. Low intensity but specific pain in the epigastric area (not always there).
1. Thyroid test negative
2. Blood tests show nothing abnormal
-Positive Billirubin count = Gilbert's Syndrome
3. Ultra sound shows evidence of fatty liver.
4. Echocardiogram done 2x shows nothing other than left ventricular volume on upper
border of normal.
5. Stress Testing (Bruce Protocol) well tolerated.
6. EKG's show a variety of abnormalities over several years including:
- Right axis deviation (consistent finding on every ECG)
- Frequent PAC's
- Nonspecific intraventricular conduction delay
- left atrial abnormality
- possible right ventricular hypertrophy
- sinus arrhythmia
7. Electrophysiology Study - normal / no mechanism found
8. 24 hour Holter monitor shows (see attachments for ECG strips):
- 596 isolated SVT ectopics (only 48 of these occurred during sleep)
- 189 couplets
- 133 runs (Paroxsymal atrial Tach. fastest being 5 beats at 236 bpm)
- sinus rhythm with occassional episodes of sinus tach. and occassional
to frequent episodes of sinus bradycardia.
- occasional PAC's some aberantly conducted with rare couplets and
- min. rate 36 bpm
- average = 70 bpm
- max RR interval was 1. 87 secs after PAC
- 422 isolated SVT ectopics (only 24 of these occurred during sleep)
- 217 couplets
- 224 episodes of PAT 3 - 185 beats in duration at rates up to 247 bpm.
- normal sinus rhythm with sinus bradycardia, sinus tach and sinus
- min. rate 30 bpm during sleep
-average = 62 bpm
- max RR interval was 2.3 seconds due to atypical wenckebach AV block
Apr. 98: (post Acid Reflux Treatment)
- 5 isolated SVT ectopics
- 0 couplets
- 0 PAT
- normal sinus rhythm with frequent sinus
- max RR interval 1.63 seconds due to sinus
9. Barium Swallow (Upper GI) - positive finding for reflux up to hypopharynx
- mild to moderate esophagitis
- bile present in stomach