Medical Technology

Yoga is a highly effective adjunct therapy in Recurrent Vasovagal Syncope

Recent research suggests that yoga can be a part of conventional therapy for vasovagal syndrome (VVS) which is a condition that causes patients to feel faint after an abrupt drop in heart rate or blood pressure.

A small, open-label, trial conducted in New Delhi, India, revealed that those who practiced yoga saw improvement in VVS symptoms after only six weeks, and a reduction of 1.82 events over the course of 12 months. All those practicing yoga also had significantly higher quality of life (QoL) scores by the end of the trial.

“Yoga as an add-on therapy for VVS is superior to medical therapy in reducing syncopal and/or presyncopal events , and improving quality of life,” reports Gautam Sharma MD, DM Centre for Integrative Medicine and Research at All India Institute of Medical Sciences in New Delhi and his colleagues. “It might be beneficial to incorporate a cost-effective, safe intervention such yoga into the management VVS.”

The results of the study were published online at JACC Clinical Electrophysiology.

Vasovagal syncope, though not life-threatening, is a frequent condition. However due to its extent and frequency it recurs, it can result in significant declines in the quality of life of the patient. They state that the current treatment strategies have been mostly ineffective.

Recent studies have demonstrated that yoga may be effective in treating autonomic imbalances. This suggests that yoga can be beneficial in VVS. To investigate this, researchers recruited adults suffering from VVS between the ages of 15-70 years with an enlightened head-up tilt test (HUTT) and at least two syncope or presyncope-like events within 3 months of enrolling. They also needed to be willing and able to practice yoga. Those with structural heart disease, accelerated hypertension, and underlying neurologic conditions were not included in the study.

55 patients were randomly selected to receive either a specialized yoga program or guideline-based therapy only. The standard treatment consisted of physical counterpressure techniques as well as avoiding triggers, a higher intake of salt, and drug therapy or pacemaking at the discretion of the treating physician.

The main outcome was a composite of the number of episodes of syncope and presyncope at 12 months.

Secondary outcomes include QoL which was measured using the World Health Organization Quality of Life Short Field questionnaire (WHOQoL BREF) and the Syncope Function Status Questionnaire (SFSQ), at 12 months as well as the head tilt test and heart rate variability at 6 weeks.

The intervention group received eight supervised yoga sessions at the Centre for Integrative Medicine and Research at the All India Institute of Medical Sciences for the initial two weeks. They continued to take yoga at home on a minimum of five times per week for the remainder of their study.

Participants were able to master yoga postures, breathing techniques, and relaxation techniques by taking a yoga module. Yoga classes were taught by certified therapists who were supervised by physicians.

Along with a book with a pictorial of the yoga regimen, participants received twice-monthly calls from the yoga center to promote the practice. The results revealed that all participants adhered to their yoga routine for more then 80 percent of the twelve-month trial.

At 12 months the mean number of syncopal or presyncopal incidents was 0.7 +- 0.7 with the yoga intervention against 2.52 +- 1.93 for patients in the control arm. (P < .05). Researchers note that the reduction in the frequency of events began in the first six weeks ago and lasted for 12 months.

Thirteen of 30 (43.3%) intervention patients and 4 of 25 (16 percent) control patients were event-free at 12 months, a statistically significant difference. (P = .02). There was a trend towards fewer positive head-up tilt results between the two groups, however this did not attain statistical significance. In addition, there was no difference in the heart rate variability at six weeks.

They found that there were no adverse reactions identified from the yoga routine, and that no patient was treated with drugs or pacing therapy during the trial.

Researchers have found that yoga postures can improve muscle tone and vascularity particularly in the lower limbs.

“Yoga breathing and relaxation techniques have been shown to increase vagal tone and improve autonomic balance, which could possibly reduce the sympathetic overdrive phase and interrupt the activation of the c-mechanoreceptors, which is a crucial element in the syncope cascade,” they write.

The authors conclude that yoga’s positive effects in this study could be due to a multidimensional impact of the exercise via both peripheral and central mechanisms. This could be due to psychological and physical pathways, and also autonomic pathways.

Comprehensive Regimen

Dhanunjaya Lekkireddy, MD is the medical director of the Kansas City Heart Rhythm Institute located in Overland Park. These results are consistent with previous research showing that yoga may improve cardiovascular function.

“All of this clearly demonstrates that when you [include] an organized diet of yoga for a reasonable amount of time to increase the amount of plasticity and parasympathetic inputs to the chest and thereby improve the cardiovascular system…you can help patients improve their symptoms,” he said. Medscape cardiology.

He already prescribes yoga as part of his own practice as part of a complete treatment plan, he said. Lakkireddy stated that there are a few practitioners in the city who practice with him.

Both he as the study’s authors stress the economic burden of VVS in terms of management and in the loss of patient productivity. “A low-cost treatment in the form of yoga, which requires only a mat, could reduce both indirect and direct costs dramatically,” note the authors.

The study was financed by the Extramural Research (EMR) scheme of the Ministry of AYUSH Government of India. The authors have not disclosed any financial connections.

JACC Clinical Electrophysiology. Published online November 24 2021. Abstract

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