Acupuncture after valve surgery is feasible and shows promise in reducing postoperative atrial fibrillation: The ACU-Heart pilot trial

Abstract

Objective: Acupuncture is an effective treatment for arrythmias and postoperative symptoms but has not been investigated after cardiac surgery. Acupuncture After Heart Surgery is a prospective, randomized, controlled pilot trial of daily inpatient acupuncture or standard care after valve surgery with the primary end point being feasibility and secondary end points being reduction in postoperative atrial fibrillation incidence and postoperative symptoms.

Methods: A total of 100 patients without a history of atrial fibrillation underwent primary valve surgery via sternotomy and randomized 1:1 to acupuncture (51) or standard care (49). The acupuncture group received daily inpatient sessions starting on postoperative day 1. Postoperative symptoms (pain, nausea, stress, anxiety) were assessed once daily in the standard care group and before/after daily intervention in the acupuncture group. The groups were comparable except for age (acupuncture: 55.6 ± 11.4 years, standard care: 61.0 ± 9.3 years; P = .01).

Results: The Acupuncture After Heart Surgery pilot trial met primary and secondary end points. There were no adverse events. An average of 3.8 (±1.1) acupuncture sessions were delivered per patient during a mean hospital stay of 4.6 days (±1.3). Acupuncture was associated with a reduction in pain, nausea, stress, and anxiety after each session (P < .0001), and patients receiving acupuncture had reduced postoperative stress and anxiety across admission compared with standard care (P = .049 and P = .036, respectively). Acupuncture was associated with reduced postoperative atrial fibrillation incidence (acupuncture: 7 [13.7%], standard care: 16 [32.7%]; P = .028), fewer discharges on amiodarone (acupuncture: 5 [9.8%], standard care: 13 [26.5%]; P = .03), and fewer hours in the intensive care unit (acupuncture: 30.3 ± 10.0, standard care: 37.0 ± 22.5; P = .057).

Conclusions: Acupuncture after valve surgery is feasible, is well tolerated, and has clinical benefit. The reduction noted in postoperative atrial fibrillation incidence will inform larger trials designed to further investigate the impact of acupuncture on postoperative atrial fibrillation and medical outcomes.

Keywords: acupuncture; cardiac surgery; clinical trial; postoperative atrial fibrillation; valve surgery.

Graphical abstract

Daily inpatient acupuncture was associated with a decreased incidence of in-hospital POAF.

Figure 1

Locations of 3 of the 9 ACU-Heart acupoints used in each acupuncture session. The PC 6 point has been shown to have antiarrhythmic properties. PC, Pericardium meridian; HT, heart meridian.

Figure 2

Enrollment flow chart. A total of 255 patients were approached for the study, 146 of whom consented to participate. An additional 45 declined and 64 were lost to follow-up. After further exclusion of 12 patients who no longer met study criteria, 134 were randomized 1:1 to SC or daily ACU. A total of 31 patients (17 SC, 14 ACU) were excluded after randomization for meeting exclusionary criteria perioperatively. Three patients withdrew from the study, all in ACU. The final sample consisted of 100 patients (49 SC, 51 ACU). SC, Standard care; ACU, acupuncture intervention.

Figure 3

Incidence of POAF and discharge on amiodarone by group. Patients in ACU had a lower incidence of POAF compared with those in SC (13.7% vs 32.7%, P = .028). Fewer patients in ACU were discharged on amiodarone (9.8% vs 26.5%, P = .03). POAF, Postoperative atrial fibrillation; SC, standard care; ACU, acupuncture intervention.

Figure 4

Severity of postoperative symptoms before and after acupuncture among the ACU participants. PNSA were each reduced after daily ACU, both with each day (P < .001) and collapsed across days (P < .001). PNSA, Pain, nausea, stress, anxiety.

Figure 5

The ACU-Heart pilot trial. Postoperative daily acupuncture in the hospital setting after valve surgery is feasible and efficacious, associated with reduced incidence of POAF, shorter ICU LOS, and reductions in postoperative PNSA. ACU, Acupuncture intervention; POD, postoperative day; SC, standard care; POAF, postoperative atrial fibrillation.

Figure E1

Study design flow. Eligible patients were approached and consented at a preoperative clinic visit, at which time they completed baseline questionnaires. Patients in ACU received daily acupuncture starting on POD 1. Daily assessments of PNSA were completed daily in SC and pre- and postacupuncture in ACU. Patients in ACU completed a questionnaire about the postoperative acupuncture experience at 3 months postoperatively. ACU, Acupuncture intervention; PNSA, pain, nausea, stress, anxiety; POD, postoperative day; SC, standard care.