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What is best practice treatment plan to treat atrial fibrillation

A:  'Tried and tested' treatments for atrial fibrillation, and with them a 'best practice treatment' don't really sit well with the concepts of Chinese medicine.

We have been asked about AF on a number of occasions, and a composite response earlier this year said:

There are some early indications that acupuncture may have an anti-arrhythmic effect in patients with atrial fibrillation. A study published earlier this year

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312232/

concluded that there appeared to be benefits and that further large scale trials would be valuable to test the hypothesis more carefully.

However, it is only fair to say that needling a single point such as Neiguan repeatedly is not a fair representation of what a traditional acupuncturist does in practice. Although there is considerable overlap between eastern and western systems the arrhythmia typical of AF could be classified in several different ways within Chinese medicine, and the practitioner would be guided by evidence other than simply a reading of the rate of the pulse. That in turn would mean that ten people with AF might receive ten different treatments. To that extent, it is not that straightforward to extrapolate from research studies like this and conclude that 'acupuncture works'. 

The skill of the practitioner lies in making sense of the symptom of AF within an entirely different theoretical framework, and understanding each presentation in each individual patient as unique. The best advice we can give any prospective patient is to contact a BAcC member local to them to seek a short face to face consultation at which they can be given a better assessment of whether acupuncture might benefit them.

The one caution with AF is that most patients are taking some form of medication to control the problem, and the cessation of medication can quickly provoke a return of the symptoms. For people involved in highly technical or responsible work this might represent a serious risk. We would always recommend that any member contemplating treating someone with a condition like AF should talk to the patient's GP to ensure that nothing they do will undermine the current treatment regime. 

We have undertaken some further searches of the literature and these two articles

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4321072/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4673375/

say much the same as the earlier articles and indeed cite them frequently.

Most of us have treated AF cases, and they do represent something of a challenge because of the management of the case alongside western treatment and medication. Even where we manage to bring the episodes under control to a greater degree than the medication most medical practitioners are reluctant to stop the meds in case the patient has a serious recurrence when they are doing something which could have dangerous consequences (driving a car, etc etc). However, good dialogue can address these kinds of problems, and a patient with their symptoms under control is likely to be happy to facilitate good communication anyway.

The other slight issue is with the setting of outcome measures. AF can come and go, and a problem-free period can happen anyway, so a practitioner has to be careful to discuss with the patient what would count as evidence from the patient's perspective that there had been some progress.

As you can see from the responses there is a strong commitment to the idea that Chinese medicine treats the individual, not the condition itself. It may have been a strategic error for us as a profession to spend so much time talking about named conditions because it has started to develop a public perception that we are doing the same as doctors  but using needles instead. The reality is that although the symptom may be the same from a Chinese medicine perspective a dozen people with AF may be treated in a dozen different ways if the practitioner discerns a different root pattern in each system which needs to be treated to restore proper flow and balance.

Adding to what has been said above, we tend to tread cautiously with patients diagnosed with AF. Sometimes the treatments offered can have their own substantial side effects, and these need to be factored into any treatment plan. However, we tend to want to work in close contact with a patient's orthodox healthcare professionals to ensure that the condition can be brought under better control without risk to the patient.

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