Increasing potassium levels can improve outcomes in patients at high risk of ventricular arrhythmia

Medical Xpress / European Society of Cardiology / New England Journal of Medicine ^ | Aug. 29, 2025 | Christian Jøns et al

[ConservativeMind]

Targeting high-normal potassium levels reduced the risk of arrhythmias, hospitalization for heart failure or arrhythmia and death compared with no intervention, according to late-breaking research.

Doctor Christian Jons: "We conducted the POTCAST trial to assess the benefits and risks of targeting high-normal potassium levels in patients at high risk of ventricular arrhythmias with an implantable cardioverter defibrillator (ICD)."

Eligible participants had an ICD or cardiac resynchronization therapy defibrillator and had a baseline plasma potassium ≤4.3 mmol/L.

Participants were randomized 1:1 to a treatment regimen aiming at increasing plasma potassium level to 4.5−5.0 mmol/L, using dietary guidance, potassium supplements and/or mineralocorticoid receptor antagonist (MRA) therapy, or to standard care.

Among 1,200 participants who had undergone randomization, median follow-up was 39.6 months. The mean age of the participants was 62.7 years. From mean baseline levels of 4.01 mmol/L, plasma potassium levels reached a mean of 4.36 mmol/L in the high-normal potassium group compared with 4.05 mmol/L in the control group after six months.

The primary endpoint was significantly lower in the high-normal potassium group (22.7%) than in the control group (29.2%; hazard ratio [HR] 0.76; 95% confidence interval [CI] 0.61 to 0.95; p=0.015). The effect was consistent across prespecified subgroups, including ischemic heart disease and heart failure.

Summing up, Professor Henning Bundgaard, senior author, said, "A treatment-induced increase in plasma potassium level of approximately 0.3 mmol/L significantly reduced the arrhythmia burden without increasing the combined risk of hyper- or hypokalemia. The benefits occurred across cardiovascular disease types and regardless of the method used to increase potassium levels, e.g. supplementation or MRAs.

"We believe the time is right to consider increasing potassium levels to the mid-to-high normal range as an inexpensive and widely available treatment strategy in patients with a broad spectrum of cardiovascular diseases associated with a high risk of ventricular arrhythmia."

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TOPICS: Health/Medicine
KEYWORDS: afib; potassium

[ConservativeMind]

More potassium seems to even help those already treated to a maximal extent.

Eat your high potassium veggies if you have arrhythmia.

[ConservativeMind]

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[Carriage Hill]

Eat your bananas!

[Highest Authority]

Be very careful with potassium if you have kidney problems.

[SendShaqtoIraq]

ARe you kidding me? I knew this when i was just a nursing AIDE back in 1977. Potassium levels are one of the FIRST things you check when someone is having V Tach

[Chickensoup]

Someone here a while back suggested low salt V8 for arrthhmias. I did and it works.

[okkev68]

Exactly, Duh!!!. When I had my many year bout with VT from an undiagnosed genetic disorder, the first thing they said was that my potassium was constantly low. I have taken prescription potassium for over 15 years now.

[E. Pluribus Unum]

I had atrial fibrillation for two solid years.

My cardiologist wanted me to drink at least 64 ounces of fluid every day.

I had a hard time drinking that much water, so I started drinking 64 ounces of low-sodium V8 Juice, every day.

Within a couple of weeks my afib reverted to normal sinus rhythm per my Kardia Mobile ecg device, and I have been in normal sinus rhythm for 380 days (more than a year for those of you in Rio Linda).

Turns out low-sodium V8 is loaded with potassium.

I am still drinking it.

Merely anecdotal evidence, but there it is

[E. Pluribus Unum]

ARe you kidding me? I knew this when i was just a nursing AIDE back in 1977. Potassium levels are one of the FIRST things you check when someone is having V Tach

Having had first-hand experience with AFIB that I had for two years that went away when I started drinking 64 ounces of low sodium V8 juice (which is loaded with potassium) every day, I am pretty sure they don't prescribe a potassium supplement because there is no money in it.

I was in heart-transplant territory, with a 15% ejection rate. I underwent cardioversion twice, with no effect. My cardiologist was talking about ablation or some sort of heart implant device, both of which are profit centers.

Then I started drinking the V8 and the AFIB went away. My ejection rate is now over 50%, which is in the normal range.

I have great respect for my cardiologist, but these days doctors are handcuffed by the bean-counters' "protocols."

I believe this graph pretty much nails the problem.

[Alas Babylon!]

Yup. I had a diagnosis of CKD Stage 3. My potassium was very high. After a lot of going to doctors and taking meds, and changing diet, I finally got it under control.

Getting an eGFR higher than 59 and a creatinine under 1.27 took a long time, but I still have high potassium.

[E. Pluribus Unum]

*

[Seaplaner]

Interestingly, OTC potassium supplements are limited to 99mg. Yet Rx pills are typically 750-1500 mg, meaning that the OTC versions are piddley small.

By comparison, one cup of V8 or one bottle of Naked brand Mango Madness each contain about 650 mg K.

[E. Pluribus Unum]

I encountered the same issue, but eventually found this:

https://www.amazon.com/dp/B0D71TG8R2?ref_=ppx_hzsearch_conn_dt_b_fed_asin_title_1

[Fresh Wind]

I also tried low-salt V-8, and it also worked for me. That product contains 20% of the MDR of potassium per 8 oz serving. That equates to 10 pills of the standard 2% potassium supplement. For 100% that means 50 pills, which is crazy.