The Paradoxical Pro-Arrhythmic Effect of Ginseng: A Case of Atrial Fibrillation in A Healthy Adult.

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. LEARNING POINTS: Herbal supplements -especially ginseng-may trigger atrial fibrillation, even in young patients without structural heart disease.Ginseng consumption has paradoxical cardiovascular effects, ranging from proarrhythmic to antiarrhythmic.Always investigate the use of over-the counter and supplemental medications when evaluating palpitations or new-onset atrial fibrillation in the emergency department or internal medicine department.