Yoga a promising adjunctive therapy for recurrent vasovagal syncope, study finds
In patients with recurrent vasovagal syncope, yoga as an adjunctive therapy was superior to standard therapy only for reducing 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, New Delhi, 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 (mean age, 39.3 years; 65.4% women). All patients had a positive head-up tilt test within the previous 3 months and 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 (n = 30) or current guideline-based therapy alone (n = 25).
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 at All India Institute of Medical Services in New Delhi, with eight supervised sessions within 2 weeks and then patients transitioned to home yoga for at least five sessions in a week. Patients attended two supervised follow-up sessions in the second month, followed by one guided session per month until month 6.
“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 primary outcome was the number of syncope and presyncope episodes at 12 months. Researchers observed a mean of 0.7 syncopal or presyncope events at 12 months in the yoga training group compared with 2.52 events in the therapy alone group (P < .01).
Thirteen (43.3%) 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 (P = .02).
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 (P < .05).
“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.