Protective effects of Wenxin Keli against cardiac arrhythmias (Review)

Cardiac arrhythmias represent a significant problem globally. Combined traditional Chinese and Western medicine is being integrated into current therapeutic trials in continued efforts to suppress arrhythmias that are predicted to escalate in the face of increasing life expectancy and medical advances. This review highlights regulatory mechanisms and major target sites of a patented, traditional Chinese drug, Wenxin Keli (WXKL). It describes the roles of individual components of WXKL via multiple pathways in interrupting reentry, reducing automaticity and preventing arrhythmogenic substrates. It further elucidates the effects of WXKL on atrial and ventricular electrophysiology, highlighting its weaker effects on rapid sodium curent (INa), as well as its multi-channel block, apart from atrial selectivity. In addition, the present review article incorporates diverse actions of WXKL in the reduction of reactive oxygen species levels, CX43 regulation, calcium handling, Ca²⁺/calmodulin-dependent protein kinase II (CaMKII) modulation and neurohumoral system regulation. Apart from its role in managing angina and heart failure shown in experimental and clinical models, the aforementioned effects enable WXKL to maintain sinus rhythm and prevent cardiac arrhythmias and sudden cardiac death associated with multiple comorbidities. Based on the results from various studies, it has minimal side-effects and is less proarrhythmic with an efficacy that matches that of western drugs. Varying effects of WXKL on multiple ion channels, intercellular conduction, and second messenger and redox systems have opened novel doors in managing arrhythmias.