Patient-reported effectiveness of strategies to convert paroxysmal atrial fibrillation to sinus rhythm in the home setting – a community-based participatory research approach

Patients with paroxysmal atrial fibrillation (AF) have limited options to terminate AF episodes in their home setting. The aims of this study were to assess patient-perceived effectiveness of self-management strategies used by patients to terminate paroxysmal AF and to investigate potential confounding factors, including patient characteristics, AF burden, and anti-arrhythmic drug use. Utilizing a community-based participatory research approach, a survey instrument was developed and deployed to AF advocacy social media groups (> 50,000 members). The reported strategies were classified based on potential physiological mechanisms into hemodynamic, autonomic, exercise, meditation/yoga, cold or heat application, breathing techniques, electrolyte/fluid/dietary supplement intake, and other interventions. An effectiveness index (EIAdj, range: 0.0 to 1.0), adjusted for confounding variables (patient characteristics, AF burden, anti-arrhythmic medication) was calculated based on how frequently the intervention was perceived to be successful and on the perceived latency of the effect. In generally healthy volunteers (n = 8), the hemodynamic responses to the combination of 500 mL ice-cold water intake, leg raising, and a modified diving response were assessed as an initial step to explore potential mechanisms and safety concerns. 606 patients from 20 countries responded to the survey. Of these, 132 patients reported at least one strategy, totaling 259 unique strategies. Fluid/electrolyte/dietary supplement intake (n = 89; EIAdj=0.44 ± 0.20, mean ± SD) and breathing techniques (n = 46; EIAdj=0.44 ± 0.20, mean ± SD) were perceived as less effective than hemodynamic interventions (mostly leg raising; n = 30; EIAdj=0.56 ± 0.21, mean ± SD, P < 0.05) and exercise (mostly brisk walking, running, or cycling; n = 41; EIAdj=0.53 ± 0.17, mean ± SD, P < 0.05). Multiple regression analysis revealed that high age, large AF burden, and β-blocker use were associated with less effectiveness (R2 = 0.14, F = 7.80 on 5 and 242 DFs, P < 0.001). The combined intervention increased stroke volume, cardiac output, and left ventricular end-diastolic volume and decreased heart rate in healthy volunteers. Hemodynamic interventions and exercise were perceived as most effective in terminating paroxysmal AF episodes in the home setting. However, high age, large AF burden, and β-blocker use appear to limit the effectiveness of home-based self-management strategies. Changes in cardiac autonomic tone and activation of atrial stretch-activated ion channels may contribute to the effectiveness of such self-management strategies.