A prospective study recently presented at the American College of Cardiology (ACC) annual meeting found that three months of twice-weekly, 90-minute yoga classes improved quality of life, depression, anxiety, and reduced the number of atrial fibrillation (AF) episodes experienced by paroxysmal patients by nearly 45 percent. This study is particularly noteworthy for this particular form of arrythmia (irregular heartbeat) has proven resistant to treatment with conventional therapies such as rhythm control medications and “minimally invasive pulmonary vein ablation procedures.”
Forty-nine physically healthy paroxysmal atrial fibrillation patients were enrolled in the study, and encouraged to do the exercise of their choice for a three-month control period (also called an extended baseline), followed by participation in three months of twice-weekly, 60-minute yoga sessions with additional daily home practice encouraged. The yoga intervention was comprised of yoga asana, pranayama, meditation, and relaxation.
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AF was assessed by holter monitors (wearable ambulatory devices that continuously monitor heart rate and heart rhythm for ~24 hours).
Importantly, patients continued to receive standard of care treatment (standard medical care regimens, including anticoagulants and antiarrhythmic drugs) during both the control and yoga periods, due to the necessity of reducing elevated stroke risk. That the number of episodes was so dramatically reduced during the yoga period is “exciting,” according to ACC president Ralph Brindis, given the noted paucity of efficacious therapies to remedy AF on a global scale.
Patients with an irregular heartbeat often suffer from high levels of anxiety and decreased quality of life, as well as increased risk of stroke. The observed reductions in experienced arrythmia episodes and anxiety are hypothesized by lead researcher Dhanunjaya Lakkireddy, MD, to stem from yoga’s modulating effects on sympathetic and parasympathetic arousal; in the disorder, abnormal surges in sympathetic and parasympathetic tone typically precede episodes, but yoga may moderate this occurrence.
Additional hypothesized mechanisms for yoga’s positive impact on decreasing episodes include the roles played by systemic stress, inflammation, and endothelial dysfunction in fostering AF; yoga has independently been shown to improve each of these markers in other studies. And of course there is the widely-cited impact of yoga on lowering blood pressure and optimizing heart-rate variability; both markers are key for optimal cardiovascular tone and rhythm.
While a promising start in the right direction, this study has several limitations that prevent us from drawing causal inferences. It did not use a randomized design or a separate control group (although the usage of the patients as their own control group for 3-months preceding the yoga sessions afforded a valuable comparison for an exploratory pilot trial such as this), and the sample size was comparatively small. It has not yet been published in a peer-reviewed journal, so the results can be viewed as preliminary.
How has yoga effected your heartbeat? What do you think about the use of yoga as an adjunct to conventional medical care for AF?