Yoga added to standard therapy may be more effective than standard therapy alone in reducing the symptomatic burden and improving quality of life in patients with recurrent vasovagal syncope (VVS), according to findings from the LIVE-Yoga study published in JACC: Clinical Electrophysiology.

The single center, open label study conducted in India randomized 55 adults between ages 15 and 70 years (mean age 39; 65% women) diagnosed with VVS who had a positive head-up tilt test and at least two syncope or presyncope events in the preceding three months to either standard therapy (control group; n=25) or yoga plus standard therapy (intervention group; n=30). Standard therapy was per the treating clinician and included counter-pressure maneuvers, avoidance of known triggers, salt and water intake augmentation, and drug therapy or pacing. The validated yoga intervention consisted of eight supervised sessions in the first two weeks, then patients continued practicing yoga at home for at least five daily sessions per week. Compliance was monitored by a twice-monthly telephone call from the yoga center and a daily self-reported yoga log maintained by patients. A syncope logbook was provided to patients to record the frequency and duration of presyncope and syncope episodes. Data were collected at six weeks, six months and 12 months.

Gautam Sharma, MD, DM, et al., found a significantly lower incidence of the primary outcome of a composite of the number of syncope or presyncope episodes at 12 months in the intervention group vs. the control group (0.7 vs. 2.52; p<0.01). The researchers note the reduction began at six weeks. The event-free analysis showed more patients were symptom free at six weeks and six months and at 12 months 43.3% of yoga intervention patients vs. 16.0% of control patients were event-free (p<0.02). Adherence to the yoga intervention was high.

Regarding secondary outcomes, yoga intervention patients had significant improvement in quality of life at 12 months as measured by the Syncope Functional Status Questionnaire and the World Health Organization Quality of Life Brief Field questionnaire.

Sharma and colleagues hypothesize that “the positive effects of yoga in this study could be related to a multidimensional effect of this intervention acting through both central and peripheral mechanisms, including physical, psychological, and autonomic pathways.”

They also note the economic burden of VVS, citing a study conducted in the U.S. showing up to 740,000 emergency visits and 460,000 hospital admissions annually were attributed to VVS. They write “it may be useful to integrate a cost-effective and safe intervention such as yoga into the management of VVS.”

In a related editorial comment, Satish R. Raj, MD, FACC, and Robert S. Sheldon, PhD, add, “The study … suggests that the addition of an ‘expert touch’ intervention to conventional nonpharmacologic therapy for VVS may accelerate this improvement. This approach should probably be given a good effort before moving on to more invasive (and likely more expensive) therapies. Whether this ‘expert touch' needs to be yoga or another intervention remains an open question. Finally, this study emphasizes the need for rigorously conducted controlled trials. Classic double-blind placebo control may not always be feasible, but in this field, similar sham arms should always be considered.”

Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Stress

Keywords: ACC International, Tilt-Table Test, India, Emergency Service, Hospital, Electrophysiology, Autonomic Pathways, World Health Organization, Self Report, Incidence, Functional Status, Financial Stress, Drinking, Double-Blind Method, Cost-Benefit Analysis, Yoga, Syncope, Vasovagal, Quality of Life

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