Acupuncture - An effective antiarrhythmic?

MILAN, ITALY. Acupuncture is probably the world’s oldest medical practice. It originated in China about 5000 years ago and was practiced in Egypt around 1250 BC. It was first described in detail in the Nei Ching, The Yellow Emperor’s Classic of Internal Medicine published about 2500 years ago (500 BC). Acupuncture has been practiced in the United States for about 150 years and received a big boost in 1971 when New York Times reporter James Reston wrote about how doctors in China used needles to ease his pain after surgery. It is estimated that over 3 million Americans used acupuncture in 2006.

Articles in peer-reviewed medical journals describe the successful use of acupuncture to deal with conditions as varied as cocaine dependency, hiccups, and pregnancy-related pelvic pain. Thus it should not come as a surprise that Italian researchers have found acupuncture effective in preventing atrial fibrillation.

Their study, published in the prestigious Journal of Cardiovascular Electrophysiology, involved 80 patients with persistent AF who had just undergone successful cardioversion. The average age of the patients was 65 years and 70% were male. About two-thirds had accompanying hypertension and one-third had diabetes. All had normal left ventricular ejection fraction (52 – 61%), a left atrial diameter of 36 – 43 mm, but no heart disease or congestive heart failure. The average time since AF diagnosis was about 3 years.

Twenty-six of the study participants (33%) had been on amiodarone prior to their cardioversion and continued on this for the duration of the study (AMIO group). The remaining patients were randomly assigned to receive acupuncture (ACU group – 17 patients), sham acupuncture (ACU-sham group – 13 patients), or no follow-up treatment (CONTROL group – 24 patients).

ACUPUNCTURE POINTS

Acupuncture involves the insertion of sharp, thin needles at very specific points in the body. These points are located on meridians and channels believed to facilitate the movement of energy (Chi, Qi) throughout the body. The three specific points used in the Italian clinical trial are:

  • Neiguan (PC-6) located on the pericardium channel about two finger’s width above the crease of the wrist on the inner arm between the two tendons. The pericardium channel controls blood flow as well as pulse rate. Stimulation of the Neiguan point has been used to counteract palpitations and a sense of fullness in the chest. There is also evidence that it help restore autonomic nervous system balance.

  • Shenmen (HT-7) is located on the heart meridian near the crease of the wrist on the side of the little finger (in the depression between the ulna and the pisiform bones). It is also called the Spirit Gate and stimulation helps calm anxiety, heart palpitations and irregular heart beat.

  • Xinshu (BL-15) is located on the bladder meridian and can be found on the left side of the back near where the 5th rib joins the vertebrae. Stimulation of Xinshu has a modulating effect on the autonomic nervous system.

The ACU group and the ACU-sham group each attended 10 weekly acupuncture sessions. In the ACU group needles were placed in the Neiguan, Shenmen and Xinshu points (on both sides of the body), while the ACU-sham group’s needles were placed in spots at least 2 cm from any known acupuncture point. During the following 12 months, afib recurred in 35 patients (44%). The recurrence rate for the four groups at 6 and 12 months are shown in the following table:

Recurrence Rate, %
Group
Treatment
6 months
12 months
AMIO
Amiodarone
18%
27%
ACU
Acupuncture
22%
35%
ACU-sham
Sham acupuncture
61%
69%
CONTROL
No treatment
50%
54%

There was no statistically significant difference between the recurrence rate in the AMIO and ACU groups. However, the recurrence rate was significantly higher in the CONTROL and ACU-sham groups.

The researchers point out that there is ample evidence that acupuncture is effective in treating both hypertension and supraventricular tachycardia. Acupuncture at the Neiguan and Xinshu points both help modulate and stabilize the autonomic nervous system, while stimulation of the Shenmen point has a calming and sedative effect on cardiac excitability. They conclude, “acupuncture treatment prevents arrhythmic recurrence after cardioversion in patients with persistent AF. This minimally invasive procedure was safe and well tolerated.”

Lomuscio, A, et al. Efficacy of acupuncture in preventing atrial fibrillation recurrences after electrical cardioversion. Journal of Cardiovascular Electrophysiology, August 30, 2010 [Epub ahead of print]

Editor’s comment: The “official” discovery that acupuncture can help recurrence of afib after cardioversion is clearly very exciting. At least two afibbers have been helped very substantially by acupuncture and their stories can be found at:

My Experience with Traditional Chinese Medicine and LAF
An Afib Success Story - Acupuncture

If acupuncture is effective in preventing recurrence after cardioversion of persistent afib, there is no reason why it would not also be effective in helping to extend the time interval between paroxysmal episodes. It certainly would seem worth a try, especially now that the exact location of the points to be stimulated has been published.