Value of Yoga Training in Paroxysmal Atrial Fibrillation

Abstract & Commentary

By John P. DiMarco, MD, PhD, Professor of Medicine, Division of Cardiology, University of Virginia, Charlottesville

Source: Lakkireddy D, et al. Effect of yoga on arrhythmia burden, anxiety, depression, and quality of life in paroxysmal atrial fibrillation: The YOGA My Heart study. J Am Coll Cardiol 2013;61:1177-1182.

In this paper, the authors report the results of a study that examined the impact of yoga training on patients with paroxysmal atrial fibrillation (AF). The authors enrolled 101 patients with paroxysmal AF who were on a stable medical regimen. Patients served as their own controls in a single-center, prospective, pre-post cohort study. Clinical characteristics and quality of life, anxiety, and depression scores were assessed at baseline, at the end of a 90-day control period, and at the end of a 90-day yoga intervention period. During the yoga intervention period, patients underwent structured Iyengar yoga training at least twice weekly. The sessions were group sessions conducted by a certified yoga instructor and lasted for at least 60 minutes. Patients were also encouraged to practice yoga at home on their own on a daily basis. The primary outcomes included the burden of symptomatic true AF, asymptomatic non-AF, and asymptomatic AF episodes. Secondary outcomes included changes in the Short Form 36 (SF-36) quality of life score, the Zung self-assessment anxiety score (SAS), and the Zung self-assessment depression score (SDS). AF burden was estimated using symptom triggered event monitors. Routine daily ECG transmissions were also made for all patients.

The study cohort included approximately equal numbers of men and women with a mean age of 61 ± 11 years. The mean duration of AF since diagnosis was 5 years. Most patients had only no or mild left atrial enlargement and a normal left ventricular ejection fraction. Hypertension and hyperlipidemia were the most common comorbid conditions. Patients with significant heart failure were not included. During the yoga intervention period, the number of symptomatic AF episodes decreased from 3.8 ± 3 to 2.1 ± 2.6. Symptomatic episodes not due to AF also decreased from 2.9 ± 3.4 to 1.4 ± 2.0. Asymptomatic AF episodes also decreased from 0.12 ± 0.44 to 0.04 ± 0.2. There were 11 patients (22% of the entire group) who had no documented AF during the yoga intervention phase. There was no change in the SF-36, the SAS, or the SDS scores during the control period. However, after the yoga intervention phase, the self-reported depression scores and self-reported anxiety scores improved significantly and the SF-36 scores improved in several domains: physical functioning, general health, vitality, social functioning, and mental health. Also noted was a decrease in resting sinus heart rate and diastolic blood pressure.

The authors conclude that this small proof-of-concept study suggests that yoga may be helpful in patients with highly symptomatic, longstanding paroxysmal AF.

Commentary

Unfortunately, both antiarrhythmic drug therapy and catheter ablation approaches are frequently unsuccessful at completely eliminating AF. Yoga has been shown to be an effective adjunct in other chronic conditions, and the preliminary data in this paper suggest that it may be an additional tool that can make recurrent AF more tolerable for patients. Yoga can produce changes in autonomic nervous system activity, and it is likely that these effects both directly decrease the frequency of AF episodes and also make episodes that do occur better tolerated.

Not all patients are likely to be candidates for yoga therapy for their AF. We also need better controlled data to demonstrate that it is effective in a typical group of AF patients. However, for patients willing to try yoga, it may be possible to decrease symptoms and make the disease more tolerable.