Acupuncture for cardiac arrhythmias: A systematic review and meta-analysis

Arrhythmia is common, and some patients respond poorly or experience adverse reactions to standard cardioversion therapies, highlighting the need for safer adjunctive options. Although acupuncture has shown potential benefits, prior reviews have primarily focused on efficacy, and no systematic evaluation of its safety in arrhythmia has been conducted. To systematically assess the risk of adverse events (AEs) associated with acupuncture in patients with cardiac arrhythmias.

A systematic search of PubMed, Web of Science, EMBASE, China National Knowledge Infrastructure, Wanfang, and VIP Database for Chinese Technical Periodicals (VIP) databases was conducted from inception to November 2025 to identify randomized controlled trials(RCTs). The primary outcome was the incidence of AEs. Risk ratios with 95% confidence intervals were pooled using a random-effects model. Subgroup analyses were performed based on control type (pharmacotherapy vs sham acupuncture). The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.

Five RCTs involving 356 participants were included. Overall, no statistically significant difference in AE risk was observed between acupuncture and control interventions (risk ratios ≈ 0.36, 95% confidence intervals: 0.07-2.01; I2 = 56.2%). Subgroup analyses suggested potential differences between control types; however, these findings are based on a small number of studies and should be interpreted with caution. In sham-controlled trials, AE incidence was low, although evidence was limited. No serious acupuncture-related AEs were reported. The certainty of evidence for AEs was rated as low.

Current evidence does not demonstrate a statistically significant difference in AE risk between acupuncture and control interventions. The overall certainty of the evidence is low, and findings should be interpreted with caution. Further high-quality RCTs are required to confirm the safety profile of acupuncture.