Doctors are being told not to prescribe Multaq to patients with permanent AF, but a key question is whether and how the results of the PALLAS apply to patients taking Multaq for the approved indications (non-permanent or paroxysmal AF).
“At this time, patients taking Multaq should talk to their healthcare professional about whether they should continue to take Multaq for non-permanent atrial fibrillation”, the FDA said (www.fda.gov/Drugs/DrugSafety/ucm264059.htm). The European Medicines Agency (EMA) has offered similar advice and is currently conducting a benefit-risk review of the drug.
Sadly, this is not the first time that Multaq has been linked with serious adverse events. Just a few months ago, the FDA issued a safety announcement alerting people about cases of rare, but severe, liver injury in patients treated with the drug. This included two cases of acute liver failure that required liver transplantation (www.fda.gov/Drugs/ DrugSafety/ucm240011.htm).
Moreover, even before the drug was approved for use, a study published in The New England Journal of Medicine reported that Multaq treatment was associated with worsening heart failure and early death in some patients (N Engl J Med, 2008; 358: 2678-87).
Despite these findings, Multaq remains on the market-albeit with a long list of precautions and warnings.
Alternatives for AF
Happily, there are safer ways to tackle AF, including some promising natural remedies. But just make sure you consult an experienced medical practitioner first.
- Follow a Mediterranean diet. This diet-typically high in whole grains, olive oil, fruits and vegetables-is considered one of the best for preventing cardiovascular disease. It may also be useful for AF, at least according to a recent study. Italian researchers discovered that people who adhered to a Mediterranean diet were less likely to have AF. Higher intakes of antioxidants-found in fruits and vegetables-were also linked to a reduced incidence of AF (Nutr Metab Cardiovasc Dis, 2011 Jul 26; Epub ahead of print).
- Watch your caffeine intake. Some studies suggest a link between caffeine and arrhythmias, while others report no connection (Am Heart J, 1998; 136: 643-6; Am J Clin Nutr, 2010; 92: 509-14). It may be that different hearts react differ-ently to caffeine, so the best way to find out if caffeine is affecting your heart is to stop your intake and see what happens.
- Limit alcohol. The research on alcohol and irregular heart rhythms is more consistent. Heavy drinkers are up to two times more likely to develop AF than those who drink moderately or not at all (Circulation, 2005; 112: 1736-42). One study found a higher risk of AF even among men who consumed a moderate two drinks a day (Arch Intern Med, 2004; 164: 1993-8).
- Stop smoking. People who smoke are more than twice as likely to have AF, according to a recent study. It was also found that people who quit smoking tend to have a lower risk of AF compared with those who continue to smoke (Heart Rhythm, 2011; 8: 1160-6).
- Avoid aspartame and MSG. A case report published in The International Journal of Cardiology suggests that the flavour enhancer monosodium glutamate (MSG) and the artificial sweetener aspartame may each have a role to play in ‘lone’ AF-the type that doesn’t involve an underlying heart problem. The report describes the case of a 57-year-old physician whose lone AF resolved after he eliminated MSG and all artificial sweet-eners from his diet. On reintro-ducing MSG and aspartame into his diet, the AF returned within a few hours (Int J Cardiol, 2009; 137: 307-8). This evidence is backed up by a survey called ‘The AFIB Report’, an online newsletter and resource centre for people with AF. According to the report, 10 per cent of AF sufferers list MSG as a trigger for their attacks, while 4 per cent list aspartame (see www.afibbers.org/faq. htm#diet). Other potential dietary triggers identified in the report include wheat, gluten, dairy and sugar. So, keep a food diary to try and pinpoint any foods, drinks or additives that might be triggering your attacks, then see if eliminating the culprit(s) helps.
- Watch out for painkillers. A study recently published in the British Medical Journal found an association between the use of common anti-inflammatory painkillers and an increased risk of AF. Compared with non-users, new users of non-selective non-steroidal anti-inflammatory drugs (NSAIDs) had a 40-per-cent increased risk of AF, while those starting treatment with COX-2 inhibitors, a newer generation of anti-inflamma-tory drugs, had a 70-per-cent increased risk of developing the disorder (BMJ, 2011; 343: d3450).
- Consider acupuncture. In one randomized controlled trial, this traditional Chinese medicine technique was nearly 20-per-cent more effective in controlling AF than the anti-arrhythmic drug amiodarone, and came with no nasty side-effects (Zhongguo Zhen Jiu, 2007; 27: 96-8). More recently, researchers in Italy concluded that acupunc-ture prevents abnormal heart rhythms from returning in AF patients treated with electrical cardioversion-which uses an electric shock to jolt the heart beat back to normal (Cardiovasc Electrophysiol, 2011; 22: 241-7).
- Give yoga a go. Stress is a likely trigger of AF in some cases, so incorporating mind- body techniques such as yoga-known to relieve stress-into your life might prove beneficial. Indeed, in a study of 49 AF patients presented at the 2011 American College of Cardiology Annual Meeting in New Orleans, researchers reported that regular yoga practice reduced the number of AF episodes by half. Also, symptoms of anxiety and depression were significantly reduced (www.medicalnewstoday. com/articles/221105.php)
- Try supplements. Magnesium supplementation in patients deficient in this essential mineral taking digoxin for arrhythmia allowed their drug dosages to be cut by half (Am J Cardiol, 1986; 57: 956-9). It may even prevent and correct arrhythmias in those who are not magnesium-deficient (Am J Cardiol, 1989; 63: 43G-6G). Also, supplementing with coenzyme Q10, copper, vitamin C and N-acetylcysteine (NAC) (Tohoku J Exp Med, 1983; 141 Suppl: 453-63; Am J Clin Nutr, 1979; 32: 1184-5; Tex Heart Inst J, 2007; 34: 268-74; Eur Heart J, 2008; 29: 625-31) has proved to be useful for patients with arrhythmias.Some studies suggest that omega-3 fatty acids may be beneficial for AF, whereas others do not (Curr Opin Clin Nutr Metab Care, 2008; 11: 94-9; JAMA, 2010; 304: 2363-72). It may depend on the type of AF you have, so consult an experienced nutritional practitioner for advice.
- Consider herbs. A number of herbal remedies have traditionally been used for arrhythmias but, as is often the case with traditional remedies, scientific studies are lacking. Extract of hawthorn berry (Crataegus oxyacantha), for example, significantly reduced arrhythmias in rats, although these results may not apply to humans (Basic Res Cardiol, 1999; 94: 71-7). A qualified herbalist can offer advice on the most suitable herbs for you.
Joanna Evans
WDDTY VOL. 22 ISSUE 6
