Atrial Fibrillation
Introduction:
Cardiac arrhythmia is a condition in which the heart’s normal rhythm is disrupted. Arrhythmias may be caused by many different factors including coronary artery disease, changes in the heart muscle, and injury from heart attack. Symptoms of arrhythmias may include a feeling of skipped heart beats, a pounding chest, dizziness or feeling of light headedness, shortness of breath, weakness or fatigue. Sometimes arrhythmias cause no symptoms. Treatment depends on the type and seriousness of the arrhythmia. Any arrhythmias should be referred by the primary care provider to a Cardiologist for evaluation. Some arrhythmias may require no treatment. For others, treatments can include medication, making lifestyle changes, and undergoing surgical procedures. Integrative treatments for risk reduction of some arrhythmias may be possible with lutein, zeaxanthin, creatine phosphate, fish oil and mustard oil.
Nutrients deficiencies and atrial fibrillation:
Elderly individuals with specifically low lutein and zeaxanthin levels may face an increased risk of atrial fibrillation (an irregular heartbeat) according to a study that included 1,847 participants aged 61-82 years. The study calculated hazard ratios after adjusting for systolic bp, diabetes, age, smoking, diabetes, alcohol use, use of bp medication, gender, congestive heart failure, recurring atrial fibrillation, and myocardial infarction. The hazard ratio for low lutein was 1.70 and for low zeaxanthin it was 1.99. Lycopene, β-cryptoxanthin, α-carotene and total carotenoids were not found to be associated with the risk of atrial fibrillation. (1)
Supplement may reduce risk of arrhythmias during and after heart surgery:
A common supplement effect on heart function, arrhythmias, and inotropic drugs: Creatine phosphate (CP) administered to patients before undergoing coronary artery surgery had beneficial effects on the heart. Patients received either CP (n=20) or standard carioplegic solution (control group, n=20). Three days before surgery, those in the CP group received 6 g of CP daily in two 20-min IV sessions. During surgery, standard cardioplegic solution enriched in CP (10 mmol/l) was given. Patients who took creatine phosphate perioperatively at an IV dose of 6 g daily in two 20-min IV sessions before cardiac bypass surgery and 4.0 g daily after surgery showed improved heart function, was beneficial for ventricular arrhythmias, needed less energy/number of DC shocks, and required less use of inotropes after surgery compared to placebo (2)
A common supplement and arrhythmias:
The use of creatine phosphate in individuals undergoing coronary artery (heart) surgery was examined in 50 patients who were administered either creatine phosphate or placebo. Findings show a reduction in arrhythmias and in patients with weakened systolic function, blood circulation results were similar when creatine phosphate was administered. Creatine did not affect the heart muscle or the level of enzymes produced when the heart is damaged. (3)
Fish oil, mustard oil and cardiac events:
Fish oil and mustard oil in non-fatal infarctions, arrhythmias, angina, and cardiac death: A 12-month, randomized, placebo-controlled trial examined the effects of fish oil versus mustard oil in 360 patients with suspected acute myocardial infarction (AMI), heart attack. Treatments were administered to all patients approximately 18 hours after symptoms of an acute MI. Patients in group A (n = 122) received fish oil 1.08 g/day orally, group B (n = 120) received mustard oil 2.9 g/day orally, and 118 patients received placebo. Results indicated a reduction in total cardiac events in patients treated with fish oil or mustard oil compared with placebo (24.5% and 28% vs 34.7%; p < 0.01). Nonfatal infarctions also occurred less frequently in patients treated with fish oil or mustard oil compared with placebo (13% and 15% vs 25.4%; p < 0.05); however, total cardiac deaths were not reduced in patients treated with mustard oil or fish oil. When compared with the placebo group, patients treated with fish oil or mustard oil showed a reduction in total angina pectoris (chest pain), cardiac arrhythmias (irregular heartbeat), and left ventricular enlargement. Diene conjugates (signal deterioration of lipids/fats) were reduced in both treatment groups, indicating antioxidant activity. (4)
Fish oil, cardiac death, arrhythmias, and all-cause mortality:
Fish oil supplementation (docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA)) was associated with a significant reduction in deaths from cardiac causes, but it was not beneficial in terms of arrhythmic events (problems with rate or rhythm of the heartbeat) or all-cause mortality. Twelve randomized controlled trials (RCTs) were included in the review (n=32,779). Supplementation with fish oil was associated with a significant 20% decrease in death from cardiac causes. (5)
Assessment and Plan: Cardiac arrhythmias, Arrhythmia, Abnormal heart rhythm
- Low lutein and zeaxanthin: Karppi J, et al found that patients with low lutein and zeaxanthin levels may face an increased risk of atrial fibrillation with calculated hazard ratio for low lutein, 1.70 and for low zeaxanthin,1.99 but lycopene, β-cryptoxanthin, α-carotene and total carotenoids were not found to be associated with the risk of atrial fibrillation (1).
- Creatine phosphate: Patients who took creatine phosphate perioperatively at an IV dose of 6 g daily in two 20-min IV sessions before cardiac bypass surgery and 4.0 g daily after surgery showed improved heart function, was beneficial for ventricular arrhythmias, needed less energy/number of DC shocks, and required less use of inotropes after surgery compared to placebo (2). Cerný J et al found that use of creatine phosphate in individuals undergoing coronary artery surgery had a reduction in arrhythmias but did not affect the level of enzymes with heart ischemia (3).
- When compared with the placebo group, patients treated with fish oil or mustard oil showed a reduction in total angina pectoris (chest pain), cardiac arrhythmias (irregular heartbeat), nonfatal infarctions, and left ventricular enlargement (4).
- A review of 2 randomized controlled trials by Leon H et al found that fish oil supplementation was associated with a 20% decrease in death from cardiac causes, but was not beneficial for decreasing arrhythmias or all-cause mortality (5).
References:
1.Karppi J, Kurl S, Mäkikallio TH, Ronkainen K, Laukkanen JA. Low levels of plasma carotenoids are associated with an increased risk of atrial fibrillation. Eur J Epidemiol. 2013 Jan;28(1):45-53. http://www.ncbi.nlm.nih.gov/pubmed/23238698
2.Cisowski M, Bochenek A, Kucewicz E, Wnuk-Wojnar AM, Morawski W, Skalski J, Grzybek H. The use of exogenous creatine phosphate for myocardial protection in patients undergoing coronary artery bypass surgery. J Cardiovasc Surg (Torino). 1996 Dec;37(6 Suppl 1):75-80. http://www.ncbi.nlm.nih.gov/pubmed/10064355
3.Cerný J, N?mec P, Bucek J, Cerný E, Papousek F, Lojek A. The effect of creatine phosphate in patients after surgery in ischemic heart disease. Czech. Vnitr Lek. 1993 Feb;39(2):153-9. http://www.ncbi.nlm.nih.gov/pubmed/8506662
4.Singh RB, Niaz MA, Sharma JP, Kumar R, Rastogi V, Moshiri M. Randomized, double-blind, placebo-controlled trial of fish oil and mustard oil in patients with suspected acute myocardial infarction: the Indian experiment of infarct survival–4. Cardiovasc Drugs Ther . 1997;11(3):485-491. http://www.ncbi.nlm.nih.gov/pubmed/9310278?dopt=Abstract
5.Leon H, Shibata M C, Sivakumaran S, Dorgan M, Chatterley T, Tsuyuki R T. Effect of fish oil on arrhythmias and mortality: systematic review. BMJ 2008 Dec 23; 337(a2931) http://www.ncbi.nlm.nih.gov/pubmed/19106137