Reversal of unstable atrial fibrillation after surgical correction of hiatus hernia: A case report

• Published in: International journal of surgery case reports Vol. 86; p. 106316
• Main Authors: de Carvalho, João Paulo Venancio, Pivetta, Luca Giovanni Antonio, Dias, Eduardo Rullo Maranhão, Antunes, Pedro de Souza Lucarrelli, Amaral, Pedro Henrique de Freitas, Roll, Sergio
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.09.2021; Elsevier
• Subjects: Atrial fibrillation; Case Report; Hiatal hernia; Laparoscopy; Hiatal hernia; Atrial fibrillation; Laparoscopy
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2021.106316

The presence of Atrial Fibrillation (AF) with herniation of abdominal content through the esophageal hiatus can be explained by the compression of the cardiac tissue by the viscera and, consequently, of its electrical transmission network, compromising the correct propagation of stimuli. Due to the causal relationship, hernia correction is almost always able to reverse the arrhythmic picture. A 75-year-old male with atrial fibrillation with a large hiatal hernia causing clinical decompensation was successfully treated after a laparocopic correction- primary closure of the defect was made with barbed surgical thread plus and placing a biological mesh (porcine small intestine submucosa, non-cross-linked), fixed with cyanoacrylate; after the procedure, he was discharged asymptomatic and with sinus heart rhythm. It is noticed that for cases in which the patient presents with a type IV hiatal hernia associated with atrial fibrillation, the laparoscopic correction of hernia using a mesh for the correction of the defect has good results in the literature. In the present case, it is noted that despite the severity of the condition denoted by hemodynamic instability and the need for electrical cardioversion, the surgical correction of the hiatal hernia was able to reverse the arrhythmic picture definitively. the concomitance of AF and hiatal hernia can explain the difficulty to control the arrhythmic picture and is necessary to consider, as soon as possible, the surgical correction of the defect as part of the treatment. •Atrial Fibrilation as a clinical manifestation of hiatus hernia•Correction of hiatus hernia by laparoscopic approach•Minimally invasive solution for a complex pathology