Olex Stephen
Department of Cardiology, Lehigh Valley Health Network, Allentown, PA, USA.
Med Acupunct. 2021 Jun 1;33(3):235-239. doi: 10.1089/acu.2021.0022. Epub 2021 Jun 16.
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.
心房颤动是最常治疗的心律失常，会导致显著的症状负担、中风风险增加，仅在美国每年就花费260亿美元。维持窦性心律通常是首选，但目前的干预措施存在局限性且伴有不良反应。有数据表明针刺对维持窦性心律可能有有益作用，也有有限的数据表明在急性情况下针刺有助于将心房颤动转为窦性心律。一名82岁女性，有射血分数保留的心力衰竭病史以及阵发性心房颤动，在因心力衰竭急性加重和胃肠道出血住院期间发生了伴有快速心室反应的心房颤动。鉴于之前一例使用耳神门穴成功转复室上性心动过速，以及有限的数据表明针刺对急性心房颤动有益，故采用针刺治疗该急性心房颤动。心律失常开始4小时后开始针刺，共使用了8个耳穴（双侧各4个）以及双侧内关穴。在最后一针针刺前心房颤动转为窦性心律，患者在住院剩余时间内心房颤动未再复发。在这种情况下，针刺似乎是心房颤动转为窦性心律的唯一原因，因为在恢复窦性心律之前未给予β受体阻滞剂、钙通道阻滞剂或抗心律失常药物。观察到的抗心律失常作用可能来自中枢介导的自主神经效应或其他机制。进一步的研究将有助于明确针刺在急性心律失常管理中的作用。
