Atrial fibrillation (AF) is the most common cardiac arrhythmia, which is related to many cardiac and cerebral vascular diseases, especially stroke. It can therefore increase cardiovascular mortality and all-cause death. The current treatments of AF remain to be western drugs and radiofrequency ablation which are limited by the tolerance of patients, adverse side effects, and high recurrence rate, especially for the elderly. On the contrary, traditional Chinese medicine (TCM) with long history of use involves various treatment methods, including Chinese herbal medicines (CHMs) or bioactive ingredients, Chinese patent medicines, acupuncture, Qigong, and Tai Chi Chuan. With more and more researches reported, the active roles of TCM in AF management have been discovered. Then it is likely that TCM would be effective preventive means and valuable additional remedy for AF. The potential mechanisms further found by numerous experimental studies showed the distinct characteristics of TCM. Some CHMs or bioactive ingredients are atrial-selective, while others are multichannel and multifunctional. Therefore, in this review we summarized the treatment strategies reported in TCM, with the purpose of providing novel ideas and directions for AF management.
Atrial fibrillation (AF) is the most common cardiac arrhythmia which will continue to grow rapidly. The estimated lifetime risk of developing AF is 25% in people over 40 years [
On the contrary, traditional Chinese medicine (TCM), as complementary and alternative treatment, therefore becomes a viable option for these AF patients. It is reported that some single Chinese herbal medicines (CHMs) or bioactive ingredients, traditional Chinese patent medicines, and nondrug methods including acupuncture, Qigong, and Tai Chi Chuan can play active roles in the four principles of AF treatment, respectively, with low adverse reaction. What is more, they can lower the degree of discomforts like palpitation, chest discomfort, and dyspnea and then increase the tolerance of patients to disease, thus obviously improving their life quality. Further, multichannels are reportedly involved in the action mechanisms, including regulation of ion channels [
CHMs have long history of use basis with the theory of TCM in China. A former research showed around 13,000 herbs were estimated to be usually used, and more than 100,000 medicinal recipes had been recorded in China [
Application of single CHMs or bioactive ingredients in AF.
Original plant | Medicinal part | Bioactive ingredient | Methods of study | Result | Mechanism | Effect on the four principles of AF |
---|---|---|---|---|---|---|
| Root | Berberine | Cellular study (rat and human atrial cells) | Vasodilation, positive ionotropic and negative chronotropic actions | Inhibition of Ito by binding to open state channels or shifting of the steady-state inactivation curve of Ito [ | Rate and rhythm control management of primary disease and risk factors |
Root | Berberine | Animal study (rabbit) | Suppressing AF | Inhibiting Ito [ | Rhythm control | |
Root | Berberine | Cellular study (guinea pig cardiac myocytes) | Multichannel ion blocker | Inhibiting KATP [ | | |
| ||||||
| Flower [ | Sesquiterpene lactone fraction [ | Animal study (rat) | Anti-inflammatory and analgesic effects [ | Stabilization of lysosomal membranes and an antiproliferative effect [ | Management of risk factors |
Flower | Acacetin | Animal study (dog) | Suppressing AF | Inhibition of Kach, Kur, and Ito as an atrial-selective agent, prolonging APD and ERP without prolonging the corrected QT interval [ | Rhythm control | |
| ||||||
| Flower heads | Catechin and epicatechin | Cellular study | Antiplatelet aggregation | Inhibiting the biosynthesis of thromboxane A2 [ | Antithrombotic therapy |
Fruit | Extract (containing flavonoid and procyanidin) | Cellular study (guinea pig ventricular myocytes) | Antiventricular arrhythmia | Prolonging the APD through blocking the delayed (IK) and inward (IK1) rectifier potassium currents [ | | |
Fruit | LI 132 (Faros® 300, CRA) [ | Animal study (Wistar rats heart) [ | Positive ionotropic action, improving exercise capacity and decreasing mortality in heart failure patients [ | Increasing Ca (2+)-concentration intracellularly [ | Management of primary disease | |
Fruit | Epicatechin, hyperoside, and fluid extract | Cellular study (DPPH and ABTS techniques) | Antioxidant activity [ | | Management of risk factors | |
| ||||||
| Tuber | Rotundium | Clinical research (AF patients) | Suppressing AF | Prolonging the ERP of atrial and atrioventricular node [ | Rhythm control |
Tuber | D-Corydaline, d-glaucine, protopine, and l-tetrahydrocolumbamine | Animal study (rat) | Antiplatelet aggregation [ | | Antithrombotic therapy | |
Tuber | Pseudocoptisine | Cellular study (RAW 264.7 murine macrophage cells) | Anti-inflammatory | Reducing levels of iNOS, COX-2, necrosis factor-alpha (TNF-alpha), and IL-6 through the inhibition of nuclear factor kappa B (NF-kappaB) activation via the suppression of ERK and p38 phosphorylation [ | Management of risk factors | |
| ||||||
| Aerial parts | Primary and refined extracts | Cellular and organ studies (rabbit, rat, and guinea pig) | Decreasing the blood pressure, heart rate and increasing coronary blood flow and treating ventricular or sinus tachyarrhythmias [ | Inhibiting the inward calcium (ICaL) and potassium (IKr) channels, lengthening Q-T, P-Q intervals and the activation time constant of I (f) in pacemaker cells [ | Rate control and management of risk factors |
Aerial parts | | Clinical research | Fibrinolysis effect and antiplatelet aggregation | Decreasing blood viscosity, fibrinogen volume and increasing the deformability of Rbc [ | Antithrombotic therapy | |
Aerial parts | Rutin and derivatives of hydroxycinnamic acid | Cellular study | Antioxidant activity [ | | Management of risk factors |
Crataegus rhipidophylla Gand. (1872) is also called hawthorn that belongs to a large genus of shrubs and trees in the family Rosaceae. It is believed to promote blood to run around the whole body in the TCM theory. Based on this theory, a research discovered that two proanthocyanidins of its flower heads, catechin and epicatechin, inhibited the biosynthesis of thromboxane A2, leading to antiplatelet effect, but may increase the risk of bleeding [
Traditional Chinese patent medicines are mainly comprised of Chinese herbal medicines or their extracts. With large numbers of clinical and experimental researches, many Chinese classical formulas are currently made into patent medicines for their efficacy, safety, and convenience. Therefore, more and more traditional Chinese patent medicines for specific diseases including AF are produced and used clinically.
Wenxin granule (WXG) is a Chinese medication, which contains
Application of Traditional Chinese patent medicines in AF.
Chinese patent medicine | Component | Methods of study | Result | Mechanism | Effect on the four principles of AF |
---|---|---|---|---|---|
Wenxin granule | | Clinical research (AF patients) [ | Shortening conversion time, decreasing the required dosage of amiodarone and avoiding the adverse reaction [ | Inhibition of INa selectivity in atrium [ | Rhythm control |
Animal study (dog) | Lowering AF inducibility after the ganglionic plexi (GP) ablation | Suppressing atrial substrate remodeling without increasing the levels of ANP, TNF- | Management of risk factors and rhythm control | ||
| |||||
Shen Song Yang Xin capsule | | Clinical research (paroxysmal AF patients) | Paroxysmal AF [ | / | Rhythm control |
Cellular study (rabbit pulmonary vein cardiomyocytes) | Prolonging APD | Depressing the ICa-L, Ito, and IK1 [ | Rhythm control | ||
Animal study (rat) [ | Treating premature ventricular contractions and ventricular arrhythmias [ | Blocking INa, ICaL, Ito, and IK1 [ | / | ||
| |||||
Shenmai injection | Ginseng saponins, radix ophiopogonis saponins, radix ophiopogonis flavonoids and traces of ginseng polysaccharides, and radix ophiopogonis polysaccharide | Clinical research | Converting AF into sinus rhythm | Prolonging ERP [ | Rhythm control |
ShenSongYangXin capsule (SSYXC) is another Chinese medication which is made up of
Shenmai injection is derived from a Chinese classical formula which is an important component of TCM and has effective function of improving palpitation symptom. The injection is composed of ginseng saponins, radix ophiopogonis saponins, radix ophiopogonis flavonoids and traces of ginseng polysaccharides, and radix ophiopogonis polysaccharide as well. A current research showed that it could prolong ERP and convert AF into sinus rhythm, thus having synergistic effects with amiodarone [
TCM involves other therapeutic methods besides drugs, including acupuncture and Qigong that are illustrated to be effective in AF. Elderly people are the crowds in high risk of developing AF, with low level of liver and kidney condition; thus they easily get into drug intoxication. Therefore, nondrug methods are viable alternative for old patients and those with low tolerance for drugs.
Acupuncture is an important and indispensable part of TCM. According to the traditional theory, many meridians and acupoints have antiarrhythmic effect, especially the Meridian of Minister of Heart that is associated with heart rate and blood flow. Neiguan spot is a spot in the area of this meridian, which locates in the middle of the forearm between the tendons [
Application of nondrug methods in AF.
Name | Methods of study | Result | Effect on the four principles of AF |
---|---|---|---|
Acupuncture | Clinical research (paroxysmal AF and atrial flutter patients) | Increasing the rate of cardioversion [ | Rhythm control |
Clinical research (paroxysmal and persistent AF patients) | Decreasing recurrences of persistent AF after cardioversion [ | Rhythm control | |
| |||
Qigong (including Baduanjin) | Clinical research | Improving physical rehabilitation of AF [ | / |
Clinical research | Reversing adverse left ventricular remodeling [ | Management of risk factors | |
Clinical research | Promoting multisystem or organ functions, increasing immunity, making bodies relax, and improving mood and confidence of elderly populations [ | Management risk factors | |
Clinical research | Lowering blood pressure [ | Management of primary disease | |
Clinical research | Modulating the blood lipid metabolism [ | Management of primary disease | |
Clinical research | Antioxidant activity and reducing oxidative stress [ | Management of risk factors | |
| |||
Tai Chi Chuan | Clinical research | Improvement of cardiorespiratory function [ | Management of risk factors |
Clinical research | Reducing CVD risk factors [ | Management of risk factors | |
A meta-analysis | Lowering blood triglyceride level [ | Management of primary disease | |
A literature search | Improvement in mental health [ | Management of risk factors |
Qigong is a special and unique part of TCM. Through physical exercises, it regulates the Qi of human body, which is a kind of material with important function, thus achieving health protection and treatment of diseases. Pippa et al. [
Tai Chi Chuan (TCC) is also known as shadow boxing. It is another way of physical exercise that is a combination of martial art and the regulation of Qi in the theory of TCM. It integrates the breath, mind, and physical activity, thus making exercisers achieve greater awareness and a sense of inner peace. TCC has been popularly accepted and practised as a health care approach and an alternative method for the reduction of symptoms and risk factors in cardiovascular diseases (Table
TCMs showed in the above researches indicate that they can work on more than one principle of AF management simultaneously through multichannels. By means of regulating ion channels [
In conclusion, despite suffering from lack of adequate mechanistic and clinical studies, TCM research in this area is exciting and may lead to the development of new drugs just like the discovery of amiodarone which is extracted from a plant named
The authors declare that they have no conflict of interests.
This work was supported by the special project of Beijing science and technology commission (no. Z161100001816045).