How Do You Treat Benign Cardiac Palpitations in Your Practice?

Treatment

This modified protocol involves using ASP^® [aiguille semi-permanente] needles, and is a semipermanent style of acupuncture that can provide ongoing treatment benefits for an extended time. The protocol excludes using the Master Cerebral needle placement, unless there is a significant overlay of poor sleep and nightmares, due to reports of discomfort when using ASP needles.

For patients who do not wish to have the ASP needles, experience has shown that, in addition to the standard protocol with standard needles, GV-20 is added during the treatment to induce a consistently improved quality of life. Augmentation with Si Shen Cong (Ex-HN-1) has helped reduce sleep and nightmare symptoms, including reduction in associated palpations, acting out dreams, and other physical manifestations. It should be noted that this effect was blunted in patients with comorbid sleep apnea who were not using CPAP [continuous positive airway pressure] devices (this form of palpitations however may not be so “benign”).

Discussion

This approach is a comprehensive solution for addressing these areas in veteran patients with greater health and wellness needs. By focusing on the auricular points, this modified protocol can address the physical and emotional stressors that can trigger palpitations, thanks to the magnets that can “re-up” the treatment on demand. The protocol can also potentially reduce reliance on pharmacologic interventions, which may be beneficial—given the side-effect profiles of those interventions—in this population.

Moreover, the use of auricular acupuncture enables a less-intense treatment session, which can be particularly beneficial for patients suffering from PTSD or anxiety disorders, who may find traditional full-body acupuncture undesirable. Auricular acupuncture can be a more tolerable and accessible treatment for these patients.

The auricular trauma protocol with ASP needles is an innovative approach that acknowledges the unique challenges and needs of the veteran population. It is a holistic approach that addresses not only the physical symptoms but also the underlying emotional and psychologic issues that often coexist.

It is important to note that acupuncture as a modality does not always lend itself to a protocol for treating patients with a diagnosis of “benign heart palpitations.” While this approach shows promise, it should be used as part of a comprehensive treatment plan. Ongoing research and clinical trials are necessary to validate auricular acupuncture's efficacy and safety further.

Conclusions

The modified auricular trauma protocol is a promising avenue for treating benign cardiac palpitations in a medically complex veteran population with comorbid conditions. By addressing the mind, body, and spirit, the protocol is a more-holistic, patient-centered approach. This method could potentially be a more-accessible and tolerable form of treatment, leading to improved health and wellness outcomes for this vulnerable population. Although the editors of Medical Acupuncture requested opining on a TCM approach only to treating a Western diagnosis, in “real world complementary holistic and integrative medicine,” the protocol is but 1 tool in the treatment toolbox.

Address correspondence to:

Jordan Goetz, MD, DABIHM, FAAMA

University of Connecticut School of Medicine

VA Connecticut Healthcare System

555 Willard Avenue

Newington

CT 06111

USA. jgmdinct@comcast.net

Palpitations are abnormally rapid or irregular beating of the heart, with a heart rate of more than 100 beats per minute. They often accompany dizziness, shortness of breath, fatigue, and chest tightness. ¹ Palpitations comprise one of the most-common medical complaints among patients who seek assistance from general practitioners, cardiologists, or emergency departments. Several etiologies are related to this condition, particularly in patients with heart disease, and, in some cases, the exact the etiology cannot be determined. ² According to the studies in the literature, the cardiac etiology is 43%, the psychiatric etiology is 31%, and ∼10% are classified as miscellaneous. ³

The treatment of palpitations—which, as noted above, are characterized by irregular or rapid heartbeats—is a complex process with several limitations and challenges. One of the primary difficulties lies in the diverse array of potential causes for the palpitations. These can range from anxiety and arrhythmias to heart disease, caffeine intake, anemia, etc. Identifying the specific cause of palpitations often necessitates extensive diagnostic testing; the intermittent nature of the condition can make it challenging to capture the exact rhythm abnormalities and triggers during a medical evaluation. ⁴

In addition, palpitations can be described subjectively by patients, and these descriptions may vary significantly from 1 individual to another, making diagnosis and treatment more challenging. ⁵ Misdiagnosis is another potential issue, as palpitations might sometimes be mistaken for other conditions, such as anxiety or panic disorders, leading to inappropriate treatments and delays in addressing the true underlying cause.

Acupuncture is a complementary and alternative approach to address palpitations. This Traditional Chinese Medicine (TCM) practice manages palpitations by addressing underlying imbalances within the body. In TCM theory, palpitations can result from disruptions in the flow of Qi, the vital energy, and Blood. Acupuncture involves insertion of fine needles into specific acupuncture points to stimulate and balance the flow of Qi, thereby regulating heart function and reducing palpitations. ⁶

Case Presentation

A 43-year-old woman presented with a 3-month history of recurrent palpitations, with no significant underlying cardiac abnormalities identified via electrocardiogram. She had a history of well-controlled hypertension, tension, and headaches. She stated that she had noticed intermittent palpitations over the past 3 months prior to presenting, accompanied by a sensation of irregular and fast heartbeats along with fatigue. She had not experienced any chest pain or shortness of breath. The palpitations lasted from 5 to 10 minutes, occurred once or twice per week, and resolved without any medications. She had no family history of early cardiac abnormalities or sudden deaths.

Acupuncture Protocol

Acupuncture treatments were performed twice weekly over 6 weeks. Based on previous literature studies,^7,8 the following acupuncture points were selected on the Heart and Pericardium meridians: HT-7; PC-6; CV-17; and GV-20. The acupuncture treatment plan was formulated to regulate Qi flow, reduce stress, and promote overall cardiovascular health.

Assessment and Follow-Up

This patient reported a gradual reduction in palpitations after the second week of acupuncture. By the end of the 6 week timeframe, her palpitations were significantly diminished, and she reported an overall improvement in her well-being. Follow-up assessments at 1 month and at 3 months post acupuncture treatments revealed sustained positive outcomes.

Discussion

This case highlights the potential benefits of acupuncture for reducing the frequency and intensity of palpitations. Acupuncture may be a viable traditional and complementary therapy for patients who are experiencing palpitations. Further research is needed to elucidate the underlying mechanisms by which acupuncture exerts its effects on cardiovascular symptoms.