S3576 Association Between Hiatal Hernia Repair and Incident Atrial Fibrillation: A Multi-Cohort TriNetX Retrospective Study

Zhexiang He; Ademola Ajibade; Thomas Elimihele; Ishtiaq Ahmad; Chenyu Sun

doi:10.14309/01.ajg.0001223556.11902.b9

Introduction: Hiatal hernia has been associated with atrial fibrillation (AF) through proposed mechanisms including left atrial compression, autonomic dysregulation, and reflux-associated inflammation. However, the effect of hiatal hernia repair on future AF risk remains unclear. We evaluated the association between hiatal hernia repair and incident AF using a large multicenter federated database with subgroup analyses by age and gender. Methods: We performed a retrospective cohort study using the TriNetX Global Collaborative Network (>170 healthcare organizations). Adult patients with diaphragmatic/hiatal hernia (ICD-10 K44) were stratified into repair and non-repair cohorts based on esophageal repair procedures. Patients with prior arrhythmia or cardiac surgery were excluded. Propensity score matching was performed using demographic variables. The primary outcome was incident AF/flutter (ICD-10 I48). Risk and Kaplan-Meier survival analyses were performed for long-term and 1-year follow-up cohorts. Subgroup analyses were conducted by age (>65 vs 18–65 years) and gender. Results: In the overall long-term matched cohort, hiatal hernia repair was associated with significantly lower incident AF compared with non-repair (2.2% vs 4.1%; RR 0.546, 95% CI 0.409–0.730, P < 0.001; hazard ratio [HR] 0.596, 95% CI 0.444–0.801, P = 0.016). Gender-stratified analysis demonstrated a significant reduction among women (2.1% vs 4.0%; RR 0.515, 95% CI 0.355–0.748, P < 0.001; HR 0.568, 95% CI 0.389–0.830, P = 0.139), whereas no significant association was observed among men (2.8% vs 2.8%; RR 0.996, 95% CI 0.570–1.741, P = 0.989; HR 1.046, 95% CI 0.593–1.844, P = 0.090). Age-stratified analysis demonstrated reduced AF risk among patients >65 years (3.0% vs 5.8%; RR 0.516, 95% CI 0.372–0.715, P < 0.001; HR 0.593, 95% CI 0.425–0.828, P = 0.031), whereas no significant association was observed among patients aged 18–65 years (1.3% vs 1.3%; RR 0.973, 95% CI 0.483–1.959, P = 0.939; HR 1.091, 95% CI 0.538–2.212, P = 0.014). One-year analyses demonstrated no early protective effect following repair in the overall cohort (RR 0.988, P = 0.957), female cohort (RR 1.510, P = 0.232), or male cohort (RR 1.258, P = 0.541). Conclusion: Hiatal hernia repair was associated with reduced long-term incident AF, particularly among older and female patients, whereas no short-term protective effect was observed within the first postoperative year. These findings suggest a delayed and phenotype-specific relationship between chronic hiatal hernia physiology and atrial remodeling.

S3576 Association Between Hiatal Hernia Repair and Incident Atrial Fibrillation: A Multi-Cohort TriNetX Retrospective Study

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