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

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.