Antiarrhythmic Effect of Acupuncture. Introduction: In traditional Chinese medicine, stimulation of the Neiguan spot has been utilized to treat palpitations. We evaluated whether acupuncture might prevent or reduce the rate of arrhythmia recurrences in patients with persistent atrial fibrillation (AF). Methods and Results: We studied 80 patients with persistent AF after restoring sinus rhythm with electrical cardioversion. Twenty-six subjects who were already on amiodarone treatment constituted the AMIO reference group. The remaining patients were randomly allocated to receive acupuncture (ACU group, n = 17), sham acupuncture (ACU-sham group, n = 13), or neither acupuncture nor antiarrhythmic therapy (CONTROL group, n = 24). Patients in the ACU and ACU-sham groups attended 10 acupuncture sessions on a once-a-week basis. Only in the former group the Neiguan, Shenmen, and Xinshu spots were punctured. During a 12-month follow-up, AF recurred in 35 patients. Cumulative AF recurrence rates in the AMIO, ACU, ACU-sham, and CONTROL patients were 27%, 35%, 69%, and 54%, respectively (P = 0.0075, log-rank test). Ejection fraction (P = 0.0005), hypertension (0.0293), and left atrial diameter (P = 0.0361) were also significantly associated with AF recurrence. Compared with AMIO group, recurrence rate was similar in ACU patients (hazard ratio: 1.15, 95% CI: 0.38-3.49; P = 0.801) but significantly higher in ACU-sham and CONTROL patients (3.77, 1.39-10; P = 0.009 and 3.15, 1.23-8.06; P = 0.017, respectively) after adjustment for ejection fraction, hypertension, and left atrial diameter using Cox modeling. Conclusion: Our data indicate that acupuncture treatment prevents arrhythmic recurrences after cardioversion in patients with persistent AF. This minimally invasive procedure was safe and well tolerated. (J Cardiovasc Electrophysiol, Vol. pp. 1-7).

Antiarrhythmic Effect of Acupuncture. Introduction: In traditional Chinese medicine, stimulation of the Neiguan spot has been utilized to treat palpitations. We evaluated whether acupuncture might prevent or reduce the rate of arrhythmia recurrences in patients with persistent atrial fibrillation (AF). Methods and Results: We studied 80 patients with persistent AF after restoring sinus rhythm with electrical cardioversion. Twenty-six subjects who were already on amiodarone treatment constituted the AMIO reference group. The remaining patients were randomly allocated to receive acupuncture (ACU group, n = 17), sham acupuncture (ACU-sham group, n = 13), or neither acupuncture nor antiarrhythmic therapy (CONTROL group, n = 24). Patients in the ACU and ACU-sham groups attended 10 acupuncture sessions on a once-a-week basis. Only in the former group the Neiguan, Shenmen, and Xinshu spots were punctured. During a 12-month follow-up, AF recurred in 35 patients. Cumulative AF recurrence rates in the AMIO, ACU, ACU-sham, and CONTROL patients were 27%, 35%, 69%, and 54%, respectively (P = 0.0075, log-rank test). Ejection fraction (P = 0.0005), hypertension (0.0293), and left atrial diameter (P = 0.0361) were also significantly associated with AF recurrence. Compared with AMIO group, recurrence rate was similar in ACU patients (hazard ratio: 1.15, 95% CI: 0.38-3.49; P = 0.801) but significantly higher in ACU-sham and CONTROL patients (3.77, 1.39-10; P = 0.009 and 3.15, 1.23-8.06; P = 0.017, respectively) after adjustment for ejection fraction, hypertension, and left atrial diameter using Cox modeling. Conclusion: Our data indicate that acupuncture treatment prevents arrhythmic recurrences after cardioversion in patients with persistent AF. This minimally invasive procedure was safe and well tolerated. (J Cardiovasc Electrophysiol, Vol. pp. 1-7).

Evidence indicates that low energy expenditure protocols derived from traditional Chinese medicine may benefit patients with cardiac impairment; therefore, the authors carried out a randomized controlled trial to test a 16-week medically assisted qi gong training program for the physical rehabilitation of patients with stable chronic atrial fibrillation and preserved left ventricular function. Functional capacity variation was evaluated using the 6-minute walk test, which was performed at baseline, at the end of the intervention, and after 16 weeks. Thirty men and 13 women (mean age, 68+/-8 years) were randomized to the intervention protocol or to a wait-list control group. Qi gong training was well tolerated and, compared with baseline, trained patients walked an average 114 meters more (27%) at the end of treatment (P<.001) and 57 meters more (13.7%) 16 weeks later (P=.008). Control subjects showed no variation in functional capacity. These results seem promising and deserve confirmation with further research.

BACKGROUND:The effects of omega-3 polyunsaturated fatty acids (PUFA) on the prevention of postoperative atrial fibrillation (POAF) are inconclusive in current studies. Moreover, the most appropriate composition of PUFA to play the protective role is unclear. The aim of this meta-analysis was to ascertain the protective role of PUFA on POAF and the most appropriate composition.

METHODS:Studies were identified through PubMed, CENTRAL, EMBASE, reviews and reference lists of relevant papers. The odds ratio (OR) was calculated for POAF. Statistical analyses were performed with Review Manager 5.0.

RESULTS:Eleven randomised controlled trials with 3137 patients were included in the analysis. The use of PUFA alone did not reduce the incidence of POAF compared with the control (OR: 0.76; 95% confidence interval [CI]: 0.57-1.03; P=0.08; I(2)=52%). However, combination therapy with PUFA and vitamins C and E reduced the incidence of POAF by 68% (OR: 0.32; 95%CI: 0.17-0.60; P=0.0005; I(2)=38%). Subgroup analysis indicated that the ratio of EPA/DHA 1:2 was effective in preventing POAF (OR: 0.35; 95%CI: 0.24-0.50; P<0.00001; I(2)=0%), while the ratio not 1:2 failed.

CONCLUSIONS:Combination therapy with PUFA and vitamins C and E is effective in the prevention of POAF while PUFA alone is not. The ratio of EPA/DHA may influence the incidence of POAF, and 1:2 may be most appropriate. Studies about PUFA on the prevention of POAF are still worthwhile to be conducted in the future.

PURPOSE: A randomized study was conducted to determine whether short-term exercise training in patients with chronic atrial fibrillation (AF) might improve exercise capacity and quality of life (QOL), and influence atrioventricular conduction.

METHODS: Atrial fibrillation patients (age 64 +/- 7 years) were randomized to exercise training (n = 15) or a 2-month control period (n = 15) followed by the training program. Twenty-four training sessions consisted of aerobic exercise and muscle strengthening. A cycle ergometer test and a 15-minute resting high-frequency spectral electrocardiogram analysis were performed and a QOL questionnaire (SF-36) was completed before and after training. Because there were no changes after 2 months in the control group, pooled data for all patients are presented before and after training. RESULTS: Cumulated work at Borg scale 17 increased by 41% +/- 36%. Heart rate at rest and after 10 minutes of exercise decreased from 75 +/- 14 to 68 +/- 14 bpm and 145 +/- 19 to 137 +/- 21 bpm, respectively. HF increased from 81 +/- 17 to 91 +/- 22 milliseconds. Four of the 8 scales and 1 of the 2 summary scales of the Short-Form-36 improved. P <.05 for all results.

CONCLUSIONS: Exercise capacity, heart rate variability, and QOL improved after 2 months of exercise training in patients with chronic AF. Heart rates at rest and during exercise decreased.

PURPOSE:Several studies have investigated the administration of vitamin C (vitC) for the prevention of postoperative atrial fibrillation (AF) after cardiac surgery. However, their findings were inconsistent. The purpose of this meta-analysis was to evaluate the efficacy of vitC as prophylaxis for the prevention of postoperative AF in cardiac surgery.

METHODS:A systematic search of PubMed, EMBASE, Google Scholar, the Cochrane Library, and clinical trial registries, was performed. 9 studies, published from August 2001 to May 2015, were included, with a total of 1,037 patients. Patients were randomized to receive vitC, or placebo.

RESULTS:Cardiac surgery patients who received vitC as prophylaxis, had a significantly lower incidence of postoperative AF (random effects OR=0.478, 95% CI 0.340 - 0.673, P<10(-4)). No significant heterogeneity was detected across the analyzed studies (I(2)=21.7%), and no publication bias or other small study-related bias was found.

CONCLUSION:Our findings suggest that VitC is effective as prophylaxis for the prevention of postoperative AF. The administration of vitC may be considered in all patients undergoing cardiac surgery.