New Study: Yoga Appears To Be A Promising Therapy For Recurrent Vasovagal Syndrome

Photo by Anupam Mahapatra on Unsplash
You may know that vasovagal syncope is fainting caused by stressful triggers that can lead to sudden drops in blood pressure and heart rate. In patients with recurrent vasovagal syncope, yoga as adjunctive therapy was superior to standard therapy only for reducing the symptomatic burden and improving quality of life, researchers reported.
“To the best of our knowledge, this study represents the first randomized controlled trial comparing yoga, over a period of 12 months, as an adjunct to routine care, in patients with recurrent vasovagal syncope,” Gautam Sharma, MD, DM, from the department of cardiology at the Centre for Integrative Medicine and Research at All India Institute of Medical Sciences and colleagues wrote in the Journal of the American College of Cardiology. “The trial showed a significantly lower incidence of the primary outcome of syncope or presyncope episodes in patients in the intervention group during the follow-up period.”

The LIVE-Yoga study included 55 patients with recurrent vasovagal syncope (avg. 39 years; 65.4% women). All patients had  at least two syncope or presyncope events 3 months before enrollment. Patients were randomly assigned to a specialized yoga training program plus current guideline-based therapy or current guideline-based therapy alone. 

Guideline-based therapy included physical counter-pressure maneuvers, avoidance of known syncope triggers, augmentation of salt and water intake, and drug therapy or pacing were initiated as determined by the treating physician. Patients in the yoga program underwent yoga training at the Center for Integrative Medicine and Research, with eight supervised sessions within two weeks. After that, patients transitioned to home yoga practice for at least five sessions in a week. Patients attended two supervised follow-up sessions after a month, followed by one guided session per month for six months. 

“The specially designed yoga module for this trial included postures, breathing, and relaxation techniques that were chosen keeping in view the pathophysiology of vasovagal

 syncope. Patients in both groups were similarly followed-up through regular telephone and video calls. Guided practice ensured safety and no adverse events were reported for the duration of the study,” the researchers wrote. 

The researchers then paid close attention to the number of syncope and presyncope episodes for 12 months afterwards. Researchers observed fewer syncopal or presyncope

events at 12 months in the yoga training group compared with 2.5 times as many events in the therapy alone group. 

Thirteen (43%) patients in the yoga training group remained free of syncope or presyncope events at 12 months compared with four (16%) patients in the therapy alone group. 

At 12 months, all Syncope Functional Status Questionnaire scores and two domains of the WHO Quality of Life Brief Field Questionnaire scores were significantly improved. 

“We postulate that 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,” the researchers wrote. 

The researchers noted several limitations of the study, including its open-label design, lack of a sham yoga group, and a lower sample size than calculated due to recruiting during the COVID-19 pandemic. 

“We believe these findings may make yoga a suitable adjunctive treatment modality for vasovagal syncope,” Sharma and colleagues wrote. 

Dr. Mark L. Meyer Dr. Meyer graduated from Haverford College with a Bachelor of Science, High Honors, in cellular and molecular biology, Phi Beta Kappa, Magna Cum Laude. He attended the Yale University School of Medicine, where he also completed a categorical residency in Internal Medicine, served for one year as an Emergency Department attending physician, and held the title of Clinical Instructor in the Department of Surgery. During this time, Dr. Meyer obtained a J.D. from the Yale Law School, concentrating on medical ethics, scientific research law, and FDA law. He then completed a fellowship in Cardiovascular Diseases at the Hospital of the University of Pennsylvania, where he obtained Level 3 Nuclear Cardiology training.

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