ATRIAL FIBRILLATION: IMMEDIATE CARDIOVERSION USING ACUPUNCTURE

Joseph M. Hetms, M.D.

ABSTRACT-- This article reviews the cardioversion through acupuncture of a surgically induced atrial fibrillation in a patient unresponsive to pharmacological management. The response occurred promptly during the first and only acupuncture treatment required in this case. The patient continued to maintain a regular sinus rhythm, off all antiarrhythmic medications, and free of symptoms, as of her last follow-up visit 6 months later.

     The following is a clinically rewarding case which reveals the power of acupuncture as a therapeutic system if properly understood and scientifically applied.
     The patient is a 64-year-old white retired teacher with a presenting complaint of atrial fibrillation of recent onset, complicated by unpleasant side effects from the drugs she was taking to control her arrhythmia.
     The history of her present illness is that five weeks prior to her arrival at the office, the patient had undergone a surgical repair (not a replacement), for mitral valve insufficiency. During the surgery, she developed atrial fibrillation, which had not converted upon her visit. She had been treated with warfarin, digoxin, and procainamide, and was suffering from adverse effects such as disorientation, dizziness, nausea, and anorexia. Although she had the beneficial effect of an improved cardiac output, she was still fatigued with any exertion stemming from even routine activities. She was scheduled for electrical cardioversion on the fourth day after this visit to the office. Her past medical history, aside from her mitral condition, was unremarkable.
     Her constitutional equation would be described as a weakness in the TAI YIN (Spleen/Lung) with a history of pulmonary infections and frequent coughs. Prior to this problem, however, she was not taking any medications. Physical examination revealed a frail and tired-appearing woman in mild respiratory distress, but well oriented and reliable. Her pulse was weak, superficial, and irregularly irregular. Her blood pressure was 130/80.

TREATMENT AND DISCUSSION
     It was considered that this woman had had trauma to her heart muscle with resultant dysfunction of her conduction system and subsequent decrease in her cardiac pump activity. Because the recent instigating event was traumatic to the head itself, it was decided to begin direct treatment to the heart by using the distinct meridian system {1). Needles in the neutral position were placed to the points of Head (HT) 1, Small Intestine (SI) 10 and Bladder (BL) 2 according to Dr. Maurice Mussat's teaching (2,3); in addition, ear points were added on one side at Sympathetic, Shen-Men, and Heart, all of which showed detectable activity when measured (4). The red and still raised mid-sternal thoracostomy scar was superficially piqured and a small area, which was starting to have a deep suture-rejec-tion reaction was surrounded with needles. All needles were left in place with light moxa for ten minutes.
     Upon evaluation, she was feeling calmer, and breathing more easily, but her pulse was still irregular. It was decided at that point to employ YANG MING as the Operator in tonification, for its dampening effect on the JUE YIN and SHAO YANG as the sympathetic and parasympathetic nervous system controls of the heart's electrical activity. This was performed by taking Large Intestine (LI) 11 and Stomach (ST) 25, connected in electrical tonification. In addition, SHAO YIN Kidney (KI) was chosen as a controller in the North to dampen the Heart activity in the South, by employing electrical tonification between KI 6' and K110. With the ear needies in place, Master of the Heart (MH) 6 was added as the inside-outside equilibrator for the upper part of the body. These needles were left in place with general moxa for another ten minutes. At the end of this treatment, her pulse had converted to a strong sinus rhythm, she was much calmer, breathing more easily, and her dizziness had improved.
     It was recommended that she increase her calcium intake which was at a level of 400 mga day to 800 mg a day for five days, later alternating it with 400 mg a day for five days over the next several months. She was also advised to carry a few crystals of rock salt with her, which she could take sublingually in the event of any excessive cardiac excitement or irregular rhythm, being cautioned not to exceed a few doses in order to avoid salt everload.
     A follow-up visit on the third day after the treatment confirmed that the patientcontinued to remain symptom-free for the weekend. She was planning to meet with her cardiologist the following morning to discuss a reduction of her medications. One week later, she continued to main-rain a regular cardiac rhythm and was symptom-free, off the procainamide, gradually decreasing the digoxin, and being maintained on warfarin.
     This case demostrates the beneficial effects of acupuncture on the electrical activity of the heart, as one applies the concepts of Energetics of Living Systems to Western medical practice. This report also indicates that these two systems can be used concomitantly to improve the patients general well-being and decrease the need for chemical or electrical cardioversion in selected patients.

REFERENCES
1. Helms, J.M. Course Chairman, UCLA Extension. Medical Acupuncture for Physicians, Santa Monica, California.

2. Mussat, M. Physique de L'Acupuncture: hypotheses et approches experimentales. Librairie le Francois, Paris. Transl. by Helms, J.M., 1983.

3. Mussat, M. Energetique des systemes vivants. Medecine et Sciences Internationales, Paris, 1982. Transl. by Helms, J.M., 1983.

4. Kropej, H. The fundamentals of ear acupuncture. Karl F. Haug Publishers, Heidelberg. Transl. by Reese-Soltesz, D.

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