Yoga Therapy for AF Yields Insight Into Brain-Heart Axis

Reed Miller

January 13, 2012

January 13, 2012 (Boston, Massachusetts) — Investigation of the antiarrhythmic benefits of yoga is continuing in several different arrhythmia populations following the encouraging results of a small trial in atrial-fibrillation patients [1].

Dr Dhanunjaya Lakkireddy (University of Kansas Hospital, Kansas City) said that his group plans to study how yoga can affect heart-rate variability and cardiac autonomic parameters in a phase 2 study that follows up on an earlier study of yoga in 49 patients with paroxysmal AF. Also, "we're exploring the effect of yoga on neurocardiogenic syncope and inappropriate sinus tachycardia, where nonphysiologic fluctuation of the cardiac autonomics plays a big role," Lakkireddy told heartwire following his presentation at the Boston Atrial Fibrillation Symposium 2012 yesterday.

"Yoga doesn't really cure atrial fibrillation, but it definitely improves the symptoms and the arrhythmia burden," he said at the symposium.

As reported by heartwire , in Lakkireddy and colleagues' phase 1 study of 49 patients with paroxysmal AF found that AF episodes were significantly reduced, with 22% having no new AF episodes while practicing BKS Iyengar yoga. Anxiety/depression scores, quality-of-life scores, resting heart rate, and systolic and diastolic blood pressure also showed some improvement in the patients, so the researchers then conducted correlation analysis to see whether these cardiovascular benefits seen in the study were related to stress reduction only or if there were an independent influence of yoga on arrhythmia, he said. The analysis showed a nonsignificant trend toward the change in anxiety levels influencing the atrial-fibrillation episodes, but a larger study might show a statistically significant relationship. Also, the changes in systolic blood pressure appear to be influencing the changes in atrial-fibrillation episodes, while improvement in resting heart rate tracked with changes in anxiety scores.

He said his group chose the BKS Iyengar system because it combines the asanas (poses) with breathing programs and meditation. There is a large body of published evidence on the pleiotropic effects of BKS Iyengar yoga and their relevance to cardiovascular health. Other programs emphasize the breathing practices more while others emphasize the asanas.

Despite the benefits, the researchers have encountered some resistance to the program. Only about half of the patients originally enrolled in their phase 1 study adhered to the prescribed yoga program after the completion of the study. Also, it appears that men are much more reluctant to try yoga than women. "Men seem to be very reluctant to be wearing spandex and doing a downward-dog pose on a yoga mat."

Combining Old and New Understandings of the Mind-Body Connection

Lakkireddy's group hypothesizes that yoga improves the plasticity and stability of the autonomic nervous system. In addition to its positive effects on stress and quality of life, "evolving evidence" suggests that yoga practice reduces the risk of arrhythmia by decreasing acute sympathetic surge while improving parasympathetic tone, Lakkireddy said. Previous studies have shown that these the autonomic effects can lead to improved heart-rate variability and blood pressure.

Men seem to be very reluctant to be wearing spandex and doing a downward-dog pose on a yoga mat.

Lakkireddy also expects his group's work to shed more light on "the systematic pleiotropic effects of yoga" such as reduced inflammation, reduced oxidative stress, and better endothelial function. He also noted that people who start a yoga program often take on other lifestyle changes such as weight loss and reduced alcohol consumption.

There is a "complex interplay" between stress and anxiety and cardiac arrhythmias along the "mind-body continuum," he said. Yoga fits into this mind-body model well, as the seven chakras can be analogously linked to the regional autonomic controls in the body, he said. Therefore, this research on yoga hopefully can contribute to a better overall understanding of the "heart-brain axis," Lakkireddy suggested.

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