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Wenxin Keli for atrial fibrillation
From US National Library of Medicine
Atrial fibrillation (AF) is a most common cardiac arrhythmia in clinical practice. In China, Wenxin Keli (WXKL) therapy is a common treatment for AF, but its effects and safety remain uncertain. This protocol is to provide the methods used to assess the effectiveness and safety of WXKL for the treatment of patients with AF.
We will search comprehensively the 4 English databases EMBASE, the Cochrane Central Register of Controlled Trials (Cochrane Library), PubMed, and Medline and 3 Chinese databases China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), and Chinese Science and Technology Periodical database (VIP) on computer on March 2018 for the randomized controlled trials (RCTs) regarding WXKL for AF. The therapeutic effects according to the sinus rhythm and p-wave dispersion (Pwd) will be accepted as the primary outcomes. We will use RevMan V.5.3 software as well to compute the data synthesis carefully when a meta-analysis is allowed.
This study will provide a high-quality synthesis of current evidence of WXKL for AF.
The conclusion of our systematic review will provide evidence to judge whether WXKL is an effective intervention for patient with AF.
PROSPERO registration number:
PROSPERO CRD 42018082045.Keywords: atrial fibrillation, protocol, systematic review, Wenxin Keli
Wenxin Keli is effective in suppressing atrial fibrillation
Wenxin Keli is a Chinese herb extract reported to be of benefit in the treatment of cardiac arrhythmias, cardiac inflammation, and heart failure.
Methods and Results
We evaluated the electrophysiologic effects of Wenxin Keli in isolated canine arterially perfused right atrial preparations with a rim of right ventricular tissue (n = 11). Transmembrane action potentials and a pseudoelectrocardiogram were simultaneously recorded. Acetylcholine (1 μM) was used to induce atrial fibrillation (AF) and to test the anti-AF potential of Wenxin Keli (5 g/L). Wenxin Keli produced preferential abbreviation of action potential duration measured at 90% repolarization (APD90) in atria, but caused atrial-selective prolongation of the effective refractory period, due to the development of postrepolarization refractoriness. The maximum rate of rise of the action potential upstroke was preferentially reduced in atria. The diastolic threshold of excitation increased in both atria and ventricles, but much more in atria. The duration of the “P wave” (index of atrial conduction time) was prolonged to a much greater extent than the duration of the “QRS complex” (index of ventricular conduction time). Wenxin Keli significantly reduced INa and shifted steady-state inactivation to more negative potentials in HEK293 cells stably expressing SCN5A. Wenxin Keli prevented the induction of persistent AF in 100% atria (6/6) and, in another experimental series, was found to terminate persistent acetylcholine-mediated AF in 100% of atria (3/3).
Wenxin Keli produces atrial-selective depression of INa-dependent parameters in canine isolated coronary-perfused preparations via a unique mechanism and is effective in suppressing AF and preventing its induction, with minimal effects on the ventricular electrophysiology.
Antiarrhythmic drugs, Atrial fibrillation, Arrhythmias, Electrophysiology, Pharmacology
ACh (acetylcholine), ADP (action potential duration), AF (atrial fibrillation), AP (action potential), CL (cycle length), DTE (diastolic threshold of excitation), ERP (effective refractory period), IKur (ultrarapid delayed rectifier potassium current), NcBe (Nardostachyschinensisbatal extract), PRR (postrepolarization refractoriness), Vmax (maximum rate of rise of the AP upstroke)