Acupuncture on Neiguan spot: A promising therapeutic approach for atrial fibrillation by modulating autonomic nerves?| Biomed Grid

Atrial fibrillation (AF) is one of the most common arrhythmias with high morbidity and mortality [2]. AF is frequently associated with heart diseases, autonomous nerve imbalance, hypertension, obstructive sleep apnea, inflammation, oxidative stress, and with a high prevalence in the elderly. Previous clinical and experimental researches have confirmed that cardiac autonomic imbalance plays a predominant role in the initiation and maintenance of AF [2-4]. In traditional Chinese medicine, Neiguan acupuncture has been used to treat cardiac arrhythmia and ischemia [5]. Multiple clinical evidences have demonstrated that Neiguan-acupuncture may be an effective approach for AF patients who underwent electrical cardioversion to restore sinus rhythm. The study by Federico Lombardi and his group [6] indicated that acupuncture of Neiguan has unequivocal effects in patients with persistent and paroxysmal AF. The recurrence rate with acupuncture is similar with oral or intravenous amiodarone on persistent AF patient, but markedly lower than the sham group. In patients with paroxysmal AF, acupuncture significantly reduce the number and duration of episodes of AF. In Chinese researches, meta-analysis of two studies [7,8] showed that for individuals with AF, acupuncture on Neiguan point was shown to be as effective as intravenous amiodarone in conversion from AF to sinus rate. Another individual study has demonstrated that acupuncture on Neiguan spot plus intravenous deslanoside had better effect on response rate than intravenous deslanoside alone [9]. FAM Jonkmant's case report [10] favored the effectiveness of acupuncture on reducing the recurrence of AF, acupuncture could be a novel approach to treatment resistant AF. But the mechanism behind acupuncture on Neiguan spot needs further elucidation.