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Background <p>Hiatal hernia (HH) is associated with up to a 19-fold increased risk of atrial fibrillation (AF). However, its impact on clinical outcomes in AF patients receiving rhythm control therapy remains unclear.</p> Methods <p>Using the TriNetX research network, we identified adult patients with AF who underwent rhythm control therapy, including antiarrhythmic drugs, cardioversion, or catheter ablation. Patients were categorized into two cohorts based on the presence or absence of HH. Clinical outcomes, including ischemic stroke, major bleeding, all-cause readmission, and heart failure (HF) exacerbation, were assessed at both 1-year and 5-year follow-up. Further subanalyses were performed to compare patients with HH who underwent surgical repair with those who did not, as well as patients with HH who underwent repair with those without HH. Propensity score matching (PSM) was applied separately to each cohort to adjust for differences in age, sex, comorbidities, and medication use, ensuring balanced baseline characteristics.</p> Results <p>We identified 2,348,576 patients with AF who underwent rhythm control strategies. Among them, 246,010 (10.5%; mean age 74.2 ± 11.0 years; 51.2% female) had HH, while 2,102,566 (89.5%; mean age 70.8 ± 12.7 years; 40.0% female) did not. After PSM, 243,376 patients were included in each cohort. The presence of HH was associated with significantly higher odds of ischemic stroke (OR 1.11, 95% CI: 1.09–1.13 at 1 year; OR 1.14, 95% CI: 1.13–1.16 at 5 years), major bleeding (OR 1.90, 95% CI: 1.86–1.93 at 1 year; OR 1.78, 95% CI: 1.75–1.80 at 5 years), and all-cause readmission (OR 1.11, 95% CI: 1.10–1.12 at 1 year; OR 1.16, 95% CI: 1.15–1.18 at 5 years) compared to patients without HH (all <i>p</i> &lt; 0.01). HH was not associated with HF exacerbation at 1 year (OR 1.00, 95% CI: 0.99–1.01, <i>p</i> = 0.68), but a modest increase was observed at 5 years (OR 1.03, 95% CI: 1.02–1.04, <i>p</i> &lt; 0.01). Among patients with symptomatic HH, surgical repair was associated with improved outcomes at 5-year follow-up compared to no repair. An additional subanalysis showed that patients with HH who underwent surgical repair had similar outcomes to those without HH.</p> Conclusion <p>In patients with AF undergoing rhythm control, the presence of HH is associated with poorer clinical outcomes. Among patients with AF and HH, surgical repair is associated with improved outcomes compared to no repair. Furthermore, HH repair is associated with outcomes similar to those observed in patients without HH, suggesting a potential benefit of surgical intervention in this population.</p> Graphical Abstract <p></p>

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Impact of hiatal hernia on clinical outcomes of rhythm control of atrial fibrillation

  • 期刊论文

  • 发表日期：

    2026年1月23日

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  • Yong Hao Yeo,
  • Hermon Kha Kin Wong,
  • Aravinthan Vignarajah,
  • Nishanthi Vigneswaramoorthy,
  • Nishaki K. Mehta

摘要

Background

Hiatal hernia (HH) is associated with up to a 19-fold increased risk of atrial fibrillation (AF). However, its impact on clinical outcomes in AF patients receiving rhythm control therapy remains unclear.

Methods

Using the TriNetX research network, we identified adult patients with AF who underwent rhythm control therapy, including antiarrhythmic drugs, cardioversion, or catheter ablation. Patients were categorized into two cohorts based on the presence or absence of HH. Clinical outcomes, including ischemic stroke, major bleeding, all-cause readmission, and heart failure (HF) exacerbation, were assessed at both 1-year and 5-year follow-up. Further subanalyses were performed to compare patients with HH who underwent surgical repair with those who did not, as well as patients with HH who underwent repair with those without HH. Propensity score matching (PSM) was applied separately to each cohort to adjust for differences in age, sex, comorbidities, and medication use, ensuring balanced baseline characteristics.

Results

We identified 2,348,576 patients with AF who underwent rhythm control strategies. Among them, 246,010 (10.5%; mean age 74.2 ± 11.0 years; 51.2% female) had HH, while 2,102,566 (89.5%; mean age 70.8 ± 12.7 years; 40.0% female) did not. After PSM, 243,376 patients were included in each cohort. The presence of HH was associated with significantly higher odds of ischemic stroke (OR 1.11, 95% CI: 1.09–1.13 at 1 year; OR 1.14, 95% CI: 1.13–1.16 at 5 years), major bleeding (OR 1.90, 95% CI: 1.86–1.93 at 1 year; OR 1.78, 95% CI: 1.75–1.80 at 5 years), and all-cause readmission (OR 1.11, 95% CI: 1.10–1.12 at 1 year; OR 1.16, 95% CI: 1.15–1.18 at 5 years) compared to patients without HH (all p < 0.01). HH was not associated with HF exacerbation at 1 year (OR 1.00, 95% CI: 0.99–1.01, p = 0.68), but a modest increase was observed at 5 years (OR 1.03, 95% CI: 1.02–1.04, p < 0.01). Among patients with symptomatic HH, surgical repair was associated with improved outcomes at 5-year follow-up compared to no repair. An additional subanalysis showed that patients with HH who underwent surgical repair had similar outcomes to those without HH.

Conclusion

In patients with AF undergoing rhythm control, the presence of HH is associated with poorer clinical outcomes. Among patients with AF and HH, surgical repair is associated with improved outcomes compared to no repair. Furthermore, HH repair is associated with outcomes similar to those observed in patients without HH, suggesting a potential benefit of surgical intervention in this population.

Graphical Abstract