Yoga may help adrenergic afibbers
KANSAS CITY, KANSAS. Yoga is a combination of physical exercises, breathing exercises and meditation that has proven benefits in improving flexibility, breathing and posture, and also in relieving stress and improving cardiovascular health. Now a group of researchers at the University of Kansas reports that yoga may also be beneficial in reducing the frequency of atrial fibrillation (AF) episodes and in improving the quality of life (QoL) in AF patients.

Their study involved 52 patients with paroxysmal AF. The average (mean) age of the study participants was 61 years (range of 50 to 72 years), 53% were female and the mean duration of AF since diagnosis was about 5 years. The average left atrial diameter was 40 mm (4.0 cm) and average left ventricular ejection fraction was 59%. Thirty-nine percent of patients had hypertension and 18% had coronary artery disease. The majority (78%) were taking antiarrhythmic medications and 63% were on beta-blockers.

The study involved two phases – a 3-month control phase followed by a 3-month yoga intervention phase. The frequency of AF episodes were compared between the two phases and clinical characteristics and QoL scores, anxiety and depression scores were determined at start of the control phase, end of control phase (beginning of yoga phase), and end of yoga phase. AF episodes were designated as symptomatic if the patient felt them and the event monitor recorded them, as symptomatic non-AF episodes if the patient felt them but the monitor did not show them, and as asymptomatic if the monitor recorded them but the patient did not feel them. The yoga intervention was based on the Iyengar protocol and consisted of 10 minutes of pranayama (breathing exercises), 10 minutes of warm-up exercises, 30 minutes of asanas (various yoga positions), and 10 minutes of relaxation exercises.

The average number of symptomatic AF episodes declined from 3.8 in the 3-month control phase to 2.1 during the yoga phase – a relative reduction of 45%. Similar reductions in AF frequency were observed for symptomatic non-AF episodes (down from 2.9 to 1.4 – a 52% relative reduction), and asymptomatic episodes (down from 0.12 to 0.04 or a relative reduction of 67%). Scores for depression and anxiety decreased significantly after the yoga phase with relative decreases of 7% and 24% respectively. Scores for various QoL domains improved significantly for physical functioning, general health, vitality, social functioning, and mental health. The yoga intervention also resulted in improved cardiovascular health as evidenced by lower blood pressure and heart rate.

The Kansas researchers conclude that yoga lessens arrhythmia burden, relieves anxiety and depression and, in general, improves quality of life in patients with paroxysmal AF. They do point out that their study was not designed to determine any possible difference in the benefits of yoga between adrenergic and vagal afibbers.
Lakkireddy, D, et al. Effect of yoga on arrhythmia burden, anxiety, depression, and quality of life in paroxysmal atrial fibrillation. Journal of the American College of Cardiology, January 25, 2013 [Epub ahead of print]

Editor's comment: Regular yoga practice decreases heart rate and increases parasympathetic (vagal) dominance of the autonomic nervous system. This would be highly beneficial to adrenergic and perhaps some mixed afibbers, but is likely to be detrimental to vagal afibbers.