Acupuncture and Metabolic–Mitochondrial Remodeling in Atrial Fibrillation: A Systematic Review and Research Recommendations

Dongyan Tu, Xiaolei Du Department of Acupuncture, Xiangshan Hospital of TCM Medical and Health Group, Ningbo, Zhejiang, People’s Republic of ChinaCorrespondence: Xiaolei Du, Department of Acupuncture, Xiangshan Hospital of TCM Medical and Health Group, Ningbo, Zhejiang, People’s Republic of China, Tel +8613736081619, Email [email protected]: To synthesize 2020– 2025 evidence on whether acupuncture (including electroacupuncture) modulates metabolic remodeling and mitochondrial function in atrial fibrillation (AF), summarize putative mechanisms, and define research priorities.Methods: PubMed, Web of Science, Embase, and CNKI were searched from January 2020 to October 2025 using controlled vocabulary and free-text terms, supplemented by backward citation tracking. Eligible publications in English or Chinese included original studies and reviews addressing AF metabolomics, mitochondrial biology, and acupuncture. Priority was given to direct AF evidence pairing an acupuncture intervention with metabolic or mitochondrial readouts. Mechanistically relevant indirect evidence was also incorporated from AF metabolic characterization studies and acupuncture-related metabolic research in other conditions. Findings were synthesized qualitatively without meta-analysis. The review was not preregistered and no formal risk-of-bias tool was applied; evidence types and uncertainty were described narratively.Results: AF is consistently associated with metabolic reprogramming in serum and atrial tissue, involving energy pathways, lipid metabolism, and amino acid/one-carbon metabolism. Mitochondrial abnormalities—impaired biogenesis, altered dynamics, and oxidative stress—are frequently linked to electrophysiological remodeling and pro-fibrotic signaling. Preclinical and small-sample clinical studies suggest acupuncture can shift metabolic profiles and improve mitochondrial-related parameters, with emerging signals implicating vagal–immune–metabolic coupling in AF models. However, rigorous randomized trials in AF patients with longitudinal metabolomics and prespecified mitochondrial endpoints remain scarce.Conclusion: Acupuncture may modulate AF-relevant metabolic and mitochondrial dysfunction through coordinated autonomic, inflammatory, and metabolic regulation. Future studies should adopt multi-timepoint multi-omics designs, STRICTA-compliant protocols, and integrated clinical–mechanistic pipelines to test causal links to electrophysiological outcomes.Keywords: atrial fibrillation, acupuncture, metabolomics, mitochondrial function, metabolic remodeling, mechanism of action