Cardioversion of Atrial Fibrillation with Acupuncture.

Atrial fibrillation, the most commonly treated arrhythmia, results in significant symptom burden, increased stroke risk, and costs 26 billion dollars annually in the United States alone. Maintaining sinus rhythm is often preferred, but current interventions have limitations and are associated with adverse effects. There are data suggesting that acupuncture can have a beneficial effect on maintaining sinus rhythm as well as limited data suggesting it can help convert atrial fibrillation to sinus rhythm in the acute setting. An 82-year-old woman with history of heart failure with preserved ejection fraction as well as paroxysmal atrial fibrillation developed atrial fibrillation with rapid ventricular response during a hospitalization for acute exacerbation of heart failure and gastrointestinal bleeding. Given success in converting supraventricular tachycardia using ear Shen Men in a prior case as well as limited data suggesting a benefit of acupuncture in acute atrial fibrillation, acupuncture was utilized in the management of the acute atrial fibrillation. Acupuncture was initiated 4 hours after the arrhythmia began and a total of 8 ear points (4 each side) as well as bilateral pericardium 6 points were utilized. Atrial fibrillation converted to sinus rhythm before the last needle was placed and the patient had no recurrence of atrial fibrillation throughout the remainder of her stay. Acupuncture appears to be solely responsible for the conversion of atrial fibrillation to sinus rhythm in this case, as no β-blockers, calcium channel blockers, or antiarrhythmic medicines were administered before the return to sinus rhythm. The antiarrhythmic effect noted may be from centrally mediated autonomic effects or additional mechanisms. Further study will help to define the role of acupuncture in the management of acute arrhythmias.