Case report Acupunct Med December 2011 Vol 29 No 4 302 INTRODUCTION Although electrical interference between implanted defibrillators and electro-acupuncture has been reported, 1 no information is available regarding electro-acupuncture ther- apy in patients with a total artificial heart (TAH) (Syncardia Inc, Tucson, Arizona, USA). We describe a case where adjunct electro-acupuncture was successfully used to treat local inflammatory arthritis in a patient with a TAH without any adverse out- comes to the patient or to the device. CASE REPORT A 44-year-old patient underwent implantation of a TAH (figure 1) for refractory heart failure of a previously transplanted heart. Unfortunately, the patient had to stay in hospital until the Food and Drug Administration (FDA) approved the portable freedom driver in the USA. The patient’s medical history included myocardial infarction from coronary embolus at the age of 28, hypertension, hyperlipidaemia, related renal insufficiency and prior orthotopic heart transplantation. During hospitalisation the patient complained of pain in the right wrist. The pain originated abruptly with a maximum intensity of 8/10. It was exacerbated by movement of the wrist and reduced by rest. There was no radiation of the pain and no other joints were involved. The patient reported no trauma to the affected wrist. A diagno- sis of inflammatory arthritis was made DISCUSSION Acupuncture Interaction between the electrical sys- tem of implanted cardiovascular devices and electrical stimulation of acupunc- ture points (electro-acupuncture) is a significant concern in the medical com- munity. 1 Acupuncture is one of the oldest medical practices that is still prac- tised today. Chinese literature points out that acupuncture originated more than 4000 years ago as part of tradi- tional Chinese medicine. Acupuncture is a substantial part of complementary and alternative medicines (CAM) in the USA and an increasing number of Americans use acupuncture for various conditions. 2 The use of acupuncture for chronic arthritis and pain control has been described with regard to the lower back and knee. 3 4 The safety of acupuncture needles has been estab- lished. The US FDA’s revised version (1 April 2010) classifies acupuncture needles as a class II medical device for general hospital and personal use. Total artificial heart Advances in therapy for coronary artery disease have resulted in a lon- ger lifespan for patients with heart failure. 5 Cardiac assist devices are increasingly being used in patients with end-stage heart failure as a bridge to transplantation, recovery or as des- tination therapy. The TAH (figure 1) is one of the many devices that are implanted in patients with advanced heart failure as a bridge to heart trans- plantation. 6 Recently, with advances in technology, the smaller portable freedom driver has enabled patients to be discharged home on the TAH. The Syncardia TAH system consists of two pulsatile artificial ventricles, one driveline for each ventricle and an exter- nal console (figure 1). The artificial pul- satile ventricles are sutured to the native atria replacing both native ventricles and the valves. The ventricles are made of a semi-rigid polyurethane housing with four flexible polyurethane dia- phragms separating the blood chamber from the air chamber. The diaphragms allow the artificial ventricles to fill and then eject blood when compressed by air from the external console. The air chamber communicates with the Electro-acupuncture therapy in a patient with a total artificial heart Radha Gopalan, 1 Robert Scott, 1 Francisco Arabia, 2 Krishnaswamy Chandrasekaran 1 Abstract Interaction between the electrical system of implanted cardiovascular devices and electrical stimulation of acupuncture points (electro-acupuncture) can be life-threatening. As a result, there is reluctance to use this modality in patients who have been implanted with any cardiac device. A patient with a total artificial heart was successfully treated with electro-acupuncture for inflammatory arthritis without any adverse events. This case illustrates the safety of electro-acupuncture in patients with a total artificial heart. after initial laboratory and imaging studies were non-specific. Paracetamol (acetaminophen) was initially pre- scribed every 8 h for pain control; although there was an initial response, it failed to adequately control the pain. Non-steroidal anti-inflammatory drugs were prohibited due to renal failure and the patient was reluctant to take narcotics. Adjunct acupuncture ther- apy was therefore recommended. The patient’s medications at the time of treatment included warfarin in a daily dose adjusted to maintain international normalised ratio of 2–3, aspirin 81 mg daily, paracetamol 650 mg daily, amlodipine 10 mg daily, clo- nidine patch #3 weekly, hydralazine 75 mg three times daily, famotidine 20 mg twice daily and dipyridamole 75 mg twice daily. The patient received acupuncture therapy in the local area of the right wrist daily for three consecutive days. The acupuncture points for therapy were selected by identifying merid- ians that traversed the right wrist and identifying tender points (Ah-Shi points) in the area according to acu- puncture point selection principles (figure 2). The needle retention time of 15 min was accompanied by electri- cal stimulation by an electro therapy device (Ito IC 1107+, Tokyo, Japan). The frequency switch was set at ‘low’ (1–20 Hz), the fine frequency control was set at ‘2’ and the intensity was adjusted to induce a sensation of pul- sations at the points stimulated. The patient’s pain was completely relieved with adjunct acupuncture therapy. group.bmj.com on January 5, 2012 - Published by aim.bmj.com Downloaded from