Acupuncture - the practice of piercing the skin with needles at specific points to treat illness or relieve pain - dramatically reduced sympathetic nerve activity among heart failure patients. The sympathetic nervous system regulates involuntary movements such as heartbeat and blood pressure. Over-activation of sympathetic nerves is common in heart failure patients and associated with a poor prognosis because it forces the weakened heart to work harder and predisposes the heart to potentially lethal heart rhythms.
"There is an ever-increasing interest in alternative medicine. But until now, no one had looked at acupuncture's effect on the very sickest heart failure patients. Our research represents a promising first step, but more study is definitely needed," says lead author Holly R. Middlekauff, M.D., associate professor of medicine at the University of California Los Angeles School of Medicine.
"Advanced heart failure patients often have two or three times more sympathetic nerve activity than normal individuals," she says. "It has been shown that the greater this activity is, the worse the outlook for the patient, so reducing it could be crucial."
In the first controlled clinical trial of its kind, the researchers divided 14 critically ill chronic heart failure patients referred for heart transplantation evaluation into three groups. One group received acupuncture at traditional acupuncture sites. The second received "non-acupoint" acupuncture in which needles were placed at sites not traditionally believed to be useful in acupuncture. Finally, the third group had a "no-needle" simulation of the treatment, in which a needle holder is tapped to the back of their neck, but no needle was inserted.
The average age of the patients in the study was 43, and they included both men and women.
Blood pressure, heart rate and sympathetic nerve activity were measured in all the patients following a four-minute mental stress test.
Mental stress was produced by having participants perform math problems in their heads and answer aloud, or by a color/word conflict test. In the word test, names of colors are written in ink different from the printed word. Participants must say the name of the color, not read the word.
The acupuncture group took the stress test again, but this time acupuncture needles were inserted and left in place for 20 minutes. After the first test, sympathetic nerve activity increased by about 25 percent, as measured by electrodes placed on nerves near the patients' knees, but there was no increase in this activity among the acupuncture patients following the second stress test.
After undergoing identical mental stress tests, patients in the "no needle" group were told that acupuncture needles were being inserted in the backs of their necks. But no needles were actually used, and no decrease in their sympathetic nerve activation during mental stress occurred, which shows that there was no placebo effect occurring, Middlekauff says. Similarly, in the non-acupoint group no decrease in their sympathetic nerve activation during mental stress occurred.
"Blood pressure and heart rate were unaffected by the acupuncture, and both increased after mental stress testing in all groups, but sympathetic nerve activation was significantly reduced in the acupuncture group," she says.
Thus, they conclude acupuncture can reduce sympathetic nerve activity in individuals with chronic heart failure.
Middlekauff says further study is needed before acupuncture could be recommend as a routine treatment for patients with severe heart failure.
"We need to do more studies in large patient populations and repeat the acupuncture procedures over a period of weeks, rather than just once, as we did in our study," she says. "But in clinical experience, acupuncture has been used successfully and with long-range results in improving hypertension, and it may also be beneficial in lowering sympathetic nerve activity."
Animal studies completed to date indicate that acupuncture works best in the most extreme cases of sympathetic nerve elevation, but the factors that cause nerve activity to increase are complex and still under investigation, Middlekauff notes.
Other researchers participating in the study are: Jun Liang Yu; Kakit Hui, M.D.; Michele Hamilton, M.D.; Gregg Fonarow, M.D.; Jaime Moriguchi, M.D.; and Antoine Hage, M.D.
For information Nov. 10 - 14, call Karen Hunter or Carole Bullock at the Hilton Anaheim Hotel
Abstract 3499 (Poster)
NR01 - 1357 (SS2001/Middlekauff)