Acupuncture treatment for cardiac arrhythmias: A systematic review of randomized controlled trials

Abstract

Cardiac arrhythmias are common [1]. The clinical manifestations range from self-limited benign discomfort, such as palpitations, to lifethreatening crisis [1]. Traditional Chinese medicine (TCM) advocate several treatment options for cardiac arrhythmias [2]. Recent scientific experimental studies suggest that acupuncture might be an effective intervention for cardiac arrhythmias through multiple mechanisms [3]. The aim of this systematic review is to critically evaluate the clinical evidence for or against the notion that acupuncture is an effective treatment for arrhythmias through the explicit searching regardless of language. The following electronic databases and registry of clinical trials were searched from their inception through October 2010: MEDLINE, CINAHL, AMED, the Cochrane library, CNKI, J-East, Korean Studies Information, DBPIA, KoreaMed, KISTI, KMbase, NDSL and WHO International Clinical Trials and clinicaltrials.gov registries. The searching strategy was as follows: acupuncture AND (cardiac arrhythmia OR sinus arrhythmia OR atrial fibrillation OR bradycardia OR atrial premature complexes OR ventricular premature complexes OR heart block OR sick sinus syndrome OR Wolff– Parkinson–White syndrome OR tachycardia OR ventricular fibrillation OR ventricular flutter). The bibliographies of the included articles were also searched for relevant studies. No restrictions were applied according to language or publication status. Only randomized and quasi-randomized controlled trials were included. Hard copies of all of the relevant articles were read, and the data were extracted by two of the authors (THK, TYC). The quality of the selected studies was assessed according to the Cochrane criteria [4]. The Cochrane collaboration's software was used for the metaanalysis (the Nordic Cochrane Centre). In total 571 potentially relevant articles were identified, 10 of which met the inclusion criteria (Fig. 1). Three studies assessed the effectiveness of the acupuncture for paroxysmal supraventricular tachycardia (PSVT) [5–7]. Two of three studies assessed the immediate effect on heart rate after one acupuncture treatment [5,6]. The results of meta-analysis did not demonstrate a statistically significant difference compared with conventional drug therapy (n=59; RR, 0.90, 95% CIs 0.73 to 1.11; I=0%) (Fig. 2A) [5,6]. The third study tested the long term treatment effect of acupuncture in PSVT patients and acupuncture generated a favorable effect on the conversion of a normal sinus rhythm (NSR) compared with medication for PSVT [7]. Three studies tested the effectiveness of acupuncture compared with the oral administration of anti-arrhythmics for the treatment of ventricular premature beat (VPB) [8–10]. The results of the metaanalysis of these three RCTs failed to reveal significant effects of acupuncture treatment on the response rate compared with antiarrhythmics (n=140; RR, 1.12, 95% CIs 0.94 to 1.35; I=42%) (Fig. 2B) [8–10]. Two RCTs tested the effects of acupuncture on atrial fibrillation (Af) [11,12]. There were significant differences in favor of acupuncture treatment in both studies [11,12]. One RCT [13] assessed the effect of a single acupuncture in patients with sinus tachycardia (ST) and showed significant effects for reducing heart rate. The other RCT [14] investigated the effects of acupuncture on patients with ventricular extrasytole (VE). The results showed significant effects of acupuncture on alleviating symptoms and reducing the number of premature beats. Adverse events (AEs) werementioned in only two of the trials and no AEs were noted in the acupuncture group [12,13] (Table 1). We explored the clinical evidence for or against acupuncture as a treatment of various types of cardiac arrhythmias. Several studies demonstrated that acupuncture may be an effective treatment of cardiac arrhythmias. However, the evidence associated with acupuncture treatment for cardiac arrhythmias is limited because the majority of the studies were of low methodological quality [15]. The paucity of rigorous RCTs and their small sample sizes is a serious limitation of the evidence.