PORTLAND, OREGON. Beta-blockers are often used as first-line treatment for arrhythmias related to an overactive sympathetic nervous system response such as for palpitations (PACs and PVCs) and adrenergically-mediated atrial fibrillation (AF). Unfortunately, there is no such thing as a natural beta-blocker. However, now Drs. Milner and Mikolai of the Center for Natural Medicine in Portland, Oregon suggest that rather than trying to correct an overly sympathetic (adrenergic) autonomic nervous system (ANS) by blocking adrenergic receptors, it may be possible to achieve a balanced ANS by increasing the activity of the parasympathetic branch of the ANS. The parasympathetic arm of the ANS is activated by the neurotransmitter acetylcholine, which is synthesized by the body from choline and vitamin B5 (pantothenic acid).

Drs. Milner and Mikolai now report good results in reducing palpitations (ectopy) and other supraventricular arrhythmias through the use of the Milner Acetylcholine Protocol (MAP). This protocol involves ingesting a water-based mixture of pantethine and choline bitartrate throughout the day. The drink is produced by mixing 500 mg of pantethine and 2000 mg of choline bitartrate in 32 fl.oz (1 liter) of pure drinking water. It is consumed during waking hours with 4 fl.oz (125 mL) being consumed continuously during the first 4 hours after arising, 8 fl.oz during the next 4 hours, 8 fl.oz during the next 4 hours, and finally, 12 fl.oz during the final 4 hours of the 16-hour "awake cycle".

If results are not satisfactory, the concentration of pantethine can be increased to 1000 mg or 1500 mg with a commensurate increase in choline bitartrate to 4000 mg or 6000 mg. In order to save cost, pantethine can also be replaced by pantothenic acid (twice the amount of pantethine) and choline bitartrate can be replaced by lecithin (2 tablespoons of lecithin per 2000 mg of choline bitartrate).

The authors provide three case studies demonstrating the effectiveness of the protocol in eliminating palpitations. They point out that the MAP is contraindicated in the case of bradycardia and AV heart blocks, and also caution against the use of pantethine and pantothenic acid by patients who are taking antiplatelet agents or anticoagulants for stroke prevention.
Mikolai, J and Milner, M. The Milner Acetylcholine Protocol (MAP) for management of cardiac dysrhythmias. Townsend Letter, February/March 2013, pp. 73-79

Editor's comment: The MAP may be useful in preventing daytime ectopics and adrenergically-mediated atrial fibrillation, but would be contraindicated for vagal AF.