Atrial fibrillation is a condition in which the heart's upper chambers quiver instead of beating regularly. This arrhythmia increases the risk of stroke, heart failure, cognitive impairment and death. Many people do not experience heart palpitations, shortness of breath or other symptoms that would bring the condition to the attention of a health care provider. Atrial fibrillation is the most common sustained arrhythmia in adults. It is a significant public health problem in the United States where it affects more than 12 million Americans and almost 10% of the population older than 80 years. It should be emphasized that the prevalence of atrial fibrillation increases with advancing age and with worsening cardiac function. Atrial fibrillation is an independent risk factor for death and greatly increases the risk for embolic stroke. In addition, this arrhythmia can be associated with hemodynamic instability, tachycardia-induced cardiomyopathy, and systemic embolism.
   Despite advances in the management of atrial fibrillation over the past two decades, the prognosis of patients newly diagnosed with atrial fibrillation - both in terms of heart failure development and survival if heart failure develops - has not improved. Digitalis treatment poses dangers. See heart arrhythmia for a full discussion and natural options.

Supplements that may benefit atrial fibrillation
Natural methods or natural supplements are rarely used by the medical community in the treatment of atrial fibrillation, but there is early research to indicate that they may be helpful.

Fish oils reduce arrhythmias. I wonder if more doctors recommended fish oils, or if patients ate more cold water fish, there would be fewer instances of atrial fibrillation or other types of cardiac arrhythmias.
Magnesium, at least intravenously, can be helpful in rapid onset atrial fibrillation. Magnesium deficiency in the diet induces heart arrhythmias.
Vitamin C may be helpful in some cases.

Magnesium and atrial fibrillation
Magnesium, when used intravenously, appears to be helpful in the acute treatment of rapid atrial fibrillation. Dr. Orhan Onalan and colleagues from the University of Toronto reviewed randomized clinical trials on the role of magnesium in the treatment of rapid atrial fibrillation. They compared the effectiveness of magnesium to placebo or antiarrhythmic drugs. Magnesium therapy was much more effective than placebo, and did not have side effects. Dr. Orhan Onalan and colleagues conclude, "intravenous magnesium administration is an effective and safe strategy for the acute management of rapid atrial fibrillation." Am J Cardiol 2007;99:1726-1732.

Vitamin C and Atrial Fibrillation
Oral vitamin C cuts the risk of early recurrence of atrial fibrillation after patients undergo electrical cardioversion. Vitamin C reduces the low-level inflammation that accompanies this condition. Early atrial fibrillation recurrence after cardioversion may be due to electrophysiological changes in the chambers of the heart. To investigate whether vitamin C reduces atrial fibrillation recurrence, a research team randomized 44 patients who had undergone cardioversion for persistent atrial fibrillation to standard therapy plus oral vitamin C or standard treatment only. Patients given the vitamin received a 2-gram loading dose 12 hours before cardioversion and 500 mg twice daily for the next 7 days. One (4 percent) of the patients given vitamin C had a relapse of atrial fibrillation, while eight (36 percent) of patients not given the vitamin did. The researchers also found that white blood cell levels and fibrinogen levels fell significantly in the group given vitamin C, but did not drop in the control patients. Markers of inflammation were also significantly higher among patients who had a recurrence of atrial fibrillation, compared with those who did not. SOURCE: International Journal of Cardiology, July 2005.

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Twice a month you will receive a brief abstract of several new studies on various supplements and natural medicine topics and their practical interpretation by Ray Sahelian, M.D. We will mention research updates on natural ways to treat or prevent atrial fibrillation.

 

Atrial fibrillation and stroke
Atrial fibrillation is a risk factor for stroke, particularly among elderly patients. Multiple trials have established that antithrombotic therapy decreases stroke risk. Aspirin is associated with a relative risk reduction of about 21% and adjusted-dose warfarin (international normalized ratio 2.0-3.0) is associated with a relative risk reduction of about 68%. Warfarin is more effective than aspirin but is used less often than indicated because of hemorrhagic risk and the inconvenience of coagulation monitoring.

Cause of atrial fibrillation
About 3 million Americans have atrial fibrillation, the most common type of irregular heartbeat, and cases are increasing as the population ages. Scientists do not know all the causes of atrial fibrillation, but its risk factors include high blood pressure, diabetes, and valvular heart disease. Recent data have also indicated that obesity is a risk. Obesity and a common sleep problem called obstructive sleep apnea may raise the risk of atrial fibrillation.
     A common cause of atrial fibrillation is an overactive thyroid gland. Steroid use could also cause atrial fribrillation. Treatment with high doses of corticosteroids, regardless of the indication, increases the risk of new-onset atrial fibrillation. In the May 8th,2006 Archives of Internal Medicine, Dr. Stricker and colleagues report that in the Rotterdam Study the risk of new-onset atrial fibrillation was significantly higher in individuals who received corticosteroids. However, high-dose corticosteroid use -- defined as oral or parenteral steroid at a daily dose of 7.5 mg /day or more of prednisone equivalents -- was more likely to cause atrial fibrillation that a lower dose. The mechanism of atrial fibrillation associated with corticosteroid use is not fully understood. High doses of corticosteroids may affect the balance of potassium in cardiac muscle cells, which may induce arrhythmia or may cause sodium and fluid retention, leading to hypertension, left atrial enlargement and congestive heart failure -- all known risk factors for atrial fibrillation.
   If you have atrial fibrillation, consider reducing or eliminating all stimulants including caffeine, some herbal teas, coffee, and herbal supplements. Try to get a deep sleep each night, reduce stress, and reduce alcohol consumption.

Obesity as risk factor of atrial fibrillation
Obesity is a cause for developing atrial fibrillation and the risk rises as body mass index (BMI) climbs.

Atrial fribrillation due to prescription medicines
Certain osteoporosis drugs, including Fosamax made by Merck Inc and Reclast by Novartis AG, are linked to atrial fibrillation. Bisphosphonates increase the rates of serious atrial fibrillation.

Alendronate, Fosamax and atrial fibrillation
Women who have ever used alendronate, also known by the trade name Fosamax, have an increased risk of atrial fibrillation. Whether the benefits of Foxamax use in terms of fracture prevention in patients with osteoporosis are outweighed by the risks of atrial fibrillation remain to be determined.

Atrial fibrillation and alcohol
Those who consume a large amount of alcohol are more likely to experience atrial fibrillation, a heart rhythm problem, than their peers who consume little alcohol.

Atrial fibrillation incidence
The number of people atrial fibrillation is higher than previously estimated and increasing. In a study of Minnesota residents, the incidence of atrial fibrillation rose more than 12 percent between 1980 and 2000. At that rate, the number of U.S. residents with the rhythm will rise to 16 million by 2050 -- nearly three times previous estimates.

Atrial fibrillation treatment
The treatment of atrial fibrillation is directed toward the prevention of thromboembolism, control of the ventricular rate and conversion to sinus rhythm. Most people who have atrial fibrillation need more than one type of treatment. Treatment options may include nonsurgical procedures, medications, medical devices such as pacemakers, or surgical procedures. Medications (anti-arrhythmics) are prescribed to restore normal sinus rhythm. The medications effectively maintain sinus rhythm for at least one year in about half of the patients treated. However, atrial fibrillation medications can cause side effects such as nausea and fatigue. Digitalis has serious side effects.

Digitalis side effects - digitalis does not improve mortality
People with atrial fibrillation who are treated with digitalis are at increased risk of death. Dr. Knut Gjesdal of the University of Oslo, Norway have found that digitalis increases exercise capacity and reduces morbidity in patients with heart failure. However, those that take digitalis have no survival benefit. Heart 2008;94:191-196.

New options for atrial fibrillation
New nonpharmacologic possibilities have emerged for the treatment of atrial fibrillation. These include surgery, radiofrequency catheter ablation, pacing, and atrial defibrillation in the treatment of atrial fibrillation.

Atrial Fibrillation Surgery
Creating circles of scar tissue in the heart works better than drugs for treating atrial fibrillation or heart flutter, Atrial fibrillation is the most common form of abnormal heart rhythm, afflicting about 2 million Americans. In a new study, researchers compared drug therapy with a procedure that involved threading a catheter into the left side of the heart and delivering radio waves to targeted areas. They used the energy to create circular patterns of scar tissue around each of four veins where abnormal electrical activity originates, a process known as ablation. The scar tissue prevents electrical pulses from escaping into the left upper chamber of the heart, the researchers said. Doctors also created two lesions in the back wall of the heart's left upper chamber and one near a valve that separates the left upper and lower chambers. Results from 99 patients showed 84 percent had normal heart rhythms for nine months after the ablation procedure, compared with 23 percent of those who took generic medications such as amiodarone or sotalol. About 40 percent of patients develop atrial fibrillation or atrial flutter after bypass or heart-valve surgery.

Atrial Fibrillation and Cognitive Function
Men with atrial fibrillation score significantly lower on cognitive performance tests than their peers without this dangerous heart arrhythmia. A variety of factors link atrial fibrillation to decreased cognitive performance, including undiagnosed stroke, lesions on the brain, and reduced cardiac output. Perhaps medications used to treat atrial fibrillation may also be a factor.

Atrial Fibrillation Research
Effects of magnesium on atrial fibrillation after cardiac surgery: a meta-analysis.
Heart. 2005 May;91(5):618-23.
To assess the efficacy of the administration of magnesium as a method for the prevention of postoperative atrial fibrillation and to evaluate its influence on hospital length of stay (LOS) and mortality. METHODS: Literature search and meta-analysis of the randomised control studies published since 1966. RESULTS: 20 randomised trials were identified, enrolling a total of 2490 patients. Study sample size varied between 20 and 400 patients. Magnesium administration decreased the proportion of patients developing postoperative AF from 28% in the control group to 18% in the treatment group (odds ratio 0.54, 95% confidence interval (CI) 0.38 to 0.75). Data on LOS were available from seven trials (1227 patients). Magnesium did not significantly affect LOS (weighted mean difference -0.07 days of stay, 95% CI -0.66 to 0.53). The overall mortality was low (0.7%) and was not affected by magnesium administration (odds ratio 1.22, 95% CI 0.39 to 3.77). CONCLUSION: Magnesium administration is an effective prophylactic measure for the prevention of postoperative atrial fibrillation. It does not significantly alter LOS or in-hospital mortality.

[Marijuana smoking and paroxysmal atrial fibrillation]
Harefuah. 2005 Jan;144(1):2-3, 72.  West Galilee Hospital, Naharia, Israel.
Atrial fibrillation -- the rapid and uncoordinated beating of the upper chambers of the heart -- is a fairly common disorder that has been linked to an increased risk of blood clots, stroke, and early death. Cannabis is the most widely used illegal drug in Israel, and unlike most of the other illegal drugs, it is common among segments of the population with higher demographic characteristics. A healthy 20 year old male patient, with two previous admissions with atrial fibrillation, was admitted to the emergency room with paroxysmal atrial fibrillation. The patient presented evidence of cannabis abuse, and no other pathologic cause for atrial fibrillation. Sinus rhythm was restored and the patient was discharged. Cannabis abuse is responsible for a wide range of pathologies, including cognitive impairment, a rise in the prevalence of lung, head and neck tumors, atrial and ventricular arrhythmias, and an increase in the risk of ischemic cardiovascular events. Cannabis abuse can induce atrial fibrillation in predisposed patients. Good practice may consider the inclusion of cannabis abuse tests in young patients admitted due to atrial fibrillation, and definite medical advice to stop the drug abuse.

n-3 Fatty acids consumed from fish and risk of atrial fibrillation or flutter: the Danish Diet, Cancer, and Health Study.
Am J Clin Nutr. 2005 Jan;81(1):50-4.
Experimental studies have shown that n-3 polyunsaturated fatty acids in fish may have antiarrhythmic properties. We examined the association between consumption of n-3 fatty acids from fish and risk of atrial fibrillation or flutter. In a prospective cohort study of 47 949 participants (mean age: 56 y) in the Danish Diet, Cancer, and Health Study, we investigated the relation between the consumption of n-3 fatty acids from fish estimated from a detailed semiquantitative food questionnaire and risk of atrial fibrillation or flutter. The subjects were followed up in the Danish National Registry of Patients for the occurrence of atrial fibrillation or flutter and in the Danish Civil Registration System (vital status and emigration). The consumption of n-3 fatty acids from fish was analyzed as sex-specific quintiles with the use of Cox proportional hazards models. During follow-up (x: 5.7 y), atrial fibrillation or flutter had developed in 556 subjects (374 men and 182 women). When the lowest quintile of n-3 fatty acids consumed from fish was used as a reference, the unadjusted hazard rate ratios in quintiles 2, 3, 4, and 5 were 0.93, 1.11, 1.10, and 1.44, respectively. Inclusion of information on the frequency of fatty fish consumption did not alter these associations. Consumption of n-3 fatty acids from fish was not associated with a reduction in risk of atrial fibrillation or flutter. We cannot exclude the possibility of residual confounding caused by a lack of information on intake of fish-oil tablets.

Atrial fibrillation emails
Q. Is there a cure for atrial fibrillation?
   A. Depending on the cause, an atrial fibrillation cure is possible. For instance, if this heart condition was due to a hyperactive thyroid, or excess thyroid medication, treating the thyroid problem can lead to a cure. But there are other causes of AF that may not have a full cure.

Q. Greetings, I have atrial fibrillation and I am taking warfarin, Digitek, and lisinopril. I am a captain and go to sea commercially and since I have problems with easy bleading I wish to get off the warfarin. I have been reading about nattokinase and I have found that not enough study has been done to to provide enough information. Is there a study being done that I could join?
   A. We are not aware of such nattokinase studies for A fib as an alternative to warfarin.

Q. I have at riel fibrillation and cannot have coffee and chocolate. Someone told me I should use carob in place of chocolate – will carob cause heart palpitations? I have been palpitation-free on several meds for 10 months and do not want to jeopardize this. I am on Coumadin and would like to stop taking it, but causing palpitations with carob would certainly take away the chance of discontinuing Coumadin. Is there caffeine or anything else in carob that would cause palpitations?
   A. Carob does not contain caffeine. However, carob has very small amounts of theobromine. I seriously doubt eating small amounts of carob, or an ounce of chocolate, would aggravate atrial fibrillation.

Q. I subscribe to your newsletter and have wanted to order Passion Rx but am hesitant. I am a 58 year old male in generally good health. I have had 2 cardiac ablations for Atrial fibrillation which is well under control for several months now. Am taking Diovan, Lotensin hctz, and Caduet for hypertension which is also under good control. I suffer from erectile dysfunction and low sex drive although my testosterone level is in the low-normal range. Do you believe that Passion Rx is safe or is the yohimbe contraindicated for me. If so, do you have a similar sexual enhancement product that I can take?
   A. Most of the herbs used for sexual enhancement can cause an increase in heart rate and would not be safe for anyone with atrial fibrillation, uncontrolled blood pressure or any type of cardiac disease. However, using very low dosages of aphrodisiac herbs, such as a quarter or a third of a capsule every other day, and being patient for a few weeks, may help some people. It is difficult to say for sure since different people respond differently. A potential supplement that could help with improving sexuality and safe for those with atrial fibrillation would be fish oils. Eating ginger herb daily could also be helpful. Certain sexual herbs and nutrients to consider in low dosage would be maca, ashwagandha, catuaba, CDP-choline and acetylcarnitine. Prostate Power Rx at half a capsule every other day is another option. Again, it is important to emphasize using a low dosage, that means taking a portion of a capsule, and having medical supervision. Passion Rx is too potent and would not be recommended to those with cardiac arrhythmias.