Impact of low-level electromagnetic fields on the inducibility of atrial fibrillation in the electrophysiology laboratory.

Abstract

BACKGROUND: Atrial fibrillation (AF) is the most common sustained arrhythmia in adults. Research suggests that autonomic nervous (ANS) system dysfunction contributes to AF pathophysiology. Animal studies have shown that low-level electromagnetic fields (LL-EMF) are potentially capable of AF suppression. This study evaluated the safety and efficacy of LL-EMF in suppressing AF in humans. OBJECTIVE: To investigate the impact of LL-EMF on AF inducibility in humans. METHODS: Patients presenting for ablation of paroxysmal AF were randomized to a sham protocol or LL-EMF (3.2 × 10 G at 0.89 Hz) applied via a Helmholtz coil around the head. AF was induced via atrial pacing, and was cardioverted if duration was greater than 15 minutes. The protocol was then run for 60 minutes, followed by reinduction of AF. The primary endpoint was the duration of pacing-induced AF after protocol completion compared between groups. RESULTS: Eighteen patients completed the study protocol (n = 10 sham, n = 8 LL-EMF). Pacing-induced AF duration in the LL-EMF group was 11.0 ± 3.43 minutes shorter than control after protocol completion (CI 3.72-18.28 minutes, = .03). A smaller proportion of LL-EMF patients experienced spontaneous firing initiating an AF episode (0/7 vs 5/6, = .0047). A significantly greater proportion of patients in the control group required direct current cardioversion after 1 hour (0.78 vs 0.13, = .02). CONCLUSION: In patients with paroxysmal AF, LL-EMF stimulation results in shorter episodes of pacing-induced AF and a reduced likelihood of spontaneous firing initiating an episode of AF.

AI evidence extraction

Main findings

Eighteen patients were randomized to sham (n=10) or LL-EMF (n=8) delivered via a Helmholtz coil around the head. After protocol completion, pacing-induced AF duration was shorter in the LL-EMF group by 11.0 ± 3.43 minutes versus control (CI 3.72–18.28; p=.03). Fewer LL-EMF patients had spontaneous firing initiating AF (0/7 vs 5/6; p=.0047), and fewer required direct current cardioversion after 1 hour (0.13 vs 0.78; p=.02).

Outcomes measured

• Duration of pacing-induced atrial fibrillation after protocol completion (primary endpoint)
• Spontaneous firing initiating an AF episode
• Need for direct current cardioversion after 1 hour

Limitations

• Small sample size (18 participants)

Suggested hubs

• clinical-therapeutic-emf (0.86)
  Randomized sham-controlled use of low-level EMF as an intervention to suppress atrial fibrillation in humans.

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    "study_type": "randomized_trial",
    "exposure": {
        "band": "ELF",
        "source": "medical/procedural (Helmholtz coil stimulation around head)",
        "frequency_mhz": null,
        "sar_wkg": null,
        "duration": "60 minutes"
    },
    "population": "Patients presenting for ablation of paroxysmal atrial fibrillation",
    "sample_size": 18,
    "outcomes": [
        "Duration of pacing-induced atrial fibrillation after protocol completion (primary endpoint)",
        "Spontaneous firing initiating an AF episode",
        "Need for direct current cardioversion after 1 hour"
    ],
    "main_findings": "Eighteen patients were randomized to sham (n=10) or LL-EMF (n=8) delivered via a Helmholtz coil around the head. After protocol completion, pacing-induced AF duration was shorter in the LL-EMF group by 11.0 ± 3.43 minutes versus control (CI 3.72–18.28; p=.03). Fewer LL-EMF patients had spontaneous firing initiating AF (0/7 vs 5/6; p=.0047), and fewer required direct current cardioversion after 1 hour (0.13 vs 0.78; p=.02).",
    "effect_direction": "benefit",
    "limitations": [
        "Small sample size (18 participants)"
    ],
    "evidence_strength": "low",
    "confidence": 0.7800000000000000266453525910037569701671600341796875,
    "peer_reviewed_likely": "yes",
    "keywords": [
        "atrial fibrillation",
        "paroxysmal AF",
        "electromagnetic fields",
        "low-level electromagnetic fields",
        "ELF",
        "Helmholtz coil",
        "sham-controlled",
        "randomized",
        "cardioversion",
        "atrial pacing"
    ],
    "suggested_hubs": [
        {
            "slug": "clinical-therapeutic-emf",
            "weight": 0.85999999999999998667732370449812151491641998291015625,
            "reason": "Randomized sham-controlled use of low-level EMF as an intervention to suppress atrial fibrillation in humans."
        }
    ]
}

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