DOI: 10.12890/2025_005913
The paradoxical pro-arrhythmic effect of ginseng: a case of atrial fibrillation in a healthy adult
Authors
sonurcaglar2582@gmail.com
Keywords
Ginseng, atrial fibrillation, arrhythmia, herbal medicineAbstract
Background: Ginseng is a popular herbal remedy widely consumed for fatigue and general well-being. While generally considered safe, it has been associated with cardiovascular side effects, including arrhythmias. However, none of the reports in the literature have described new-onset atrial fibrillation (AF) associated with ginseng in a young, healthy patient, as in our case.
Case description: A 29-year-old female presented to the emergency department complaining of palpitations for a few hours. She reported consuming red ginseng capsules, which was kept at home, at a dose of 500 mg orally twice daily for the past 2 months due to complaints of fatigue, muscle pain, weakness, and exhaustion as a traditional remedy. The patient had no past medical history. The patient’s physical examination revealed no pathologic signs except for tachycardia and an irregular pulse rate. An electrocardiogram showed a ventricular rate of 123 beats/min, consistent with AF. Sinus rhythm was achieved rapidly after administration of 0.25 mg/kg intravenous diltiazem.
Conclusion: This is the first case report in the literature of new-onset AF after high-dose ginseng use in a young, healthy individual with no cardiac history, suggesting a possible association between AF and ginseng use. This case highlights the arrhythmogenic potential of ginseng and underscores the importance of evaluating the use of herbal supplements in patients presenting with AF.
References
- Potenza MA, Montagnani M, Santacroce L, Charitos IA, Bottalico L. Ancient herbal therapy: A brief history of Panax ginseng. J Ginseng Res 2023;47:359-365. doi: 10.1016/j.jgr.2022.03.004
- Jafari A, Kordkatuli K, Mardani H, Mehdipoor F, Bakhtiari Jami P, et al. Ginseng supplementation and cardiovascular disease risk factors: a protocol for GRADE-assessed systematic review and dose-response meta-analysis. BMJ Open 2024;14:e080926. doi: 10.1136/bmjopen-2023-080926
- Zhou J, Zhang J, Jing P, Lan Y, Cao X, Feng H, et al. Ginseng in white and red processed forms: Ginsenosides and cardiac side effects. Food Sci Nutr 2023;12:1857-1868. doi: 10.1002/fsn3.3879
- Zhang ZB, Yu CY, Wang HY, Jia XB, Wu W, Pang ST, et al. The history, beneficial ingredients, mechanism, processing, and products of Panax ginseng for medicinal and edible value. Food & Medicine Homology 2025;2:9420059. doi: 10.26599/FMH.2025.9420059
- Sun Y, Liu Y, Chen K. Roles and mechanisms of ginsenoside in cardiovascular diseases: progress and perspectives. Science China Life Sci 2016;59:292-298. doi: 10.1007/s11427-016-5007-8
- Wang T, Zhao H, Chen Y, Guo S, Zhou C, Cao H, et al. Ginsenoside Rg1 exerts anti-arrhythmic effect by inhibiting ICaL through cAMP-PKA and PI3K-AKT signaling pathways in rat ventricular myocytes after myocardial ischemia-reperfusion injury. Science Progress 2025;108:p00368504251341113. doi: 10.1177/00368504251341113
- Liu L, Hu J, Mao Q, Liu C, He H, Hui X, et al. Functional compounds of ginseng and ginseng-containing medicine for treating cardiovascular diseases. Front Pharmacol 2022;13:1034870. doi: 10.3389/fphar.2022.1034870
- Torbey E, Abi Rafeh N, Khoueiry G, Kowalski M, Bekheit S. Ginseng: a potential cause of long QT. J Electrocardiol 2011;44:357-358. doi: 10.1016/j.jelectrocard.2010.08.007
- Paik DJ, Lee CH. Review of cases of patient risk associated with ginseng abuse and misuse. J Ginseng Res 2015;39:89-93. doi: 10.1016/j.jgr.2014.11.005
- Liao WI, Lin YY, Chu SJ, Hsu CW, Tsai SH. Bradyarrhythmia caused by ginseng in a patient with chronic kidney disease. Am J Emerg Med 2010;28:538.e5-6. doi: 10.1016/j.ajem.2009.08.006
- Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981;30:239-245. doi: 10.1038/clpt.1981.154
