“Many patients with paroxysmal atrial fibrillation (AF) can’t live their lives as they want to – they refuse dinners with friends, concerts, and travelling – because they are afraid of an AF episode occurring,” said Maria Wahlström, a nurse and PhD candidate at Sophiahemmet University and the Karolinska Institute in Stockholm, Sweden.
“AF episodes are accompanied by chest pain, dyspnoea and dizziness,” continued Ms Wahlström. “These symptoms are unpleasant and patients feel anxious, worried and stressed that an AF episode will occur. Most patients are still working and take sick leave to visit the hospital. Many patients with AF use complementary therapies so it is necessary to find out if they actually help.”
AF is the most common cardiac rhythm disorder, affecting 1.5-2% of the general population in the developed world.2 There is no cure for AF, and management focuses on relief of symptoms and the prevention of complications such as stroke using cardioversion, ablation and medication.3
Patients with paroxysmal AF experience episodes of AF that usually last less than 48 hours and stop by themselves, although in some patients they can last up to seven days.4 The current study included 80 patients with paroxysmal AF who were randomised to yoga or a control group that did not do yoga. Both groups received standard treatment with medication, cardioversion and catheter ablation as needed.
Yoga was performed for one hour, once a week, for 12 weeks in the hospital with an experienced instructor. The yoga programme included light movements, deep breathing, and meditation.
Quality of life, heart rate and blood pressure were measured in all patients at the start and end of the study. Quality of life (physical and mental health) was assessed using two validated questionnaires, the Short-Form Health Survey (SF-36) and the EuroQoL-5D (EQ-5D) Visual Analogue Scale (VAS).
After 12 weeks, the yoga group had higher SF-36 mental health scores, lower heart rate, and lower systolic and diastolic blood pressure than the control group.
Ms Wahlström said: “We found that patients who did yoga had a better quality of life, lower heart rate and lower blood pressure than patients who did not do yoga. If could be that the deep breathing balances the parasympathetic and sympathetic nervous system, leading to less variation in heart rate. The breathing and movement may have beneficial effects on blood pressure.”
Within the yoga group, both the EQ-5D VAS scores and SF-36 mental health scores improved during the study, while there was no change in the control group between the initial and final measurements.
“Yoga may improve quality of life in patients with paroxysmal AF because it gives them a method to gain some self control over their symptoms instead of feeling helpless,” said Ms Wahlström. “Patients in the yoga group said it felt good to let go of their thoughts and just be inside themselves for awhile.”
The researchers have started a larger study in 140 patients with symptomatic paroxysmal AF who will be randomised to yoga, music relaxation, or a control group. This will clarify whether the movement and deep breathing in yoga are beneficial or only the relaxation. It will also address the potential for group therapy itself to be beneficial, since patients may feel safe and secure when they meet others with the same illness.
Ms Wahlström concluded: “A lot of the patients I meet who have paroxysmal AF are very stressed. Yoga should be offered as a complementary therapy to help them relax. It may also reduce their visits to hospital by lowering their anxiety until an AF episode stops.”
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DISCLOSURES: None.
References
1Wahlström M, Rydell Karlsson M, Medin J, Frykman V. Effects of yoga in patients with paroxysmal atrial fibrillation – a randomized controlled study. European Journal of Cardiovascular Nursing. DOI: 10.1177/1474515116637734
2Camm AJ, Lip GYH, De Caterina R, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation. European Heart Journal. 2012;33:2719-2747.
3Camm AJ, Kirchhof P, Lip GYH, et al. Guidelines for the management of atrial fibrillation. European Heart Journal. 2010;31:2369-2429.
4Patient information about atrial fibrillation is available here
About the European Journal of Cardiovascular Nursing
The European Journal of Cardiovascular Nursing is the international journal of the European Society of Cardiology dedicated to the advancement of knowledge in the field of cardiovascular nursing: promoting evidence based clinical practice.
About the European Society of Cardiology
The European Society of Cardiology (ESC) represents more than 95 000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.
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