By Mark L. Fuerst
Reviewed by Philip Green, MD, Assistant in Clinical Medicine, Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York

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Newer nonpharmacologic treatment options for atrial fibrillation (AF), including advances in radiofrequency catheter ablation and AF surgery, have led to substantial improvements in the treatment of the disease. However, AF can still cause disabling and bothersome symptoms that adversely affect a patient’s quality of life. One way to help manage the disease and improve quality of life may be to add adjunctive complementary and alternative therapies, such as yoga, meditation, acupuncture, therapeutic hypnosis, or tai chi into routine care.

Evidence that yoga may be beneficial comes from a recent small cohort study showing that the regular practice of yoga improves symptoms, arrhythmia burden, heart rate, blood pressure, anxiety and depression scores, and several domains of quality of life among patients with paroxysmal AF.1 Three months of yoga training reduced both symptomatic and asymptomatic AF episodes and improved quality-of-life parameters, including physical functioning, general health, vitality, social functioning, and mental health. This is not the first study to test the effects of yoga in the management of cardiovascular disease, but it is the first one to evaluate the role of yoga in AF.

The authors propose several possible physiologic explanations for their findings: an increase in parasympathetic tone; enhanced balance between the 2 autonomic nervous system components; reduced systemic inflammation and oxidative stress; and decreased progression of arrhythmia by preventing or attenuating atrial remodeling. They also suggest patients benefit from the emotionally supportive atmosphere at yoga centers and the caring relationships formed there, as well as changes in diet and lifestyle modification often associated with yoga practice.

Previous research has evaluated other noninvasive strategies, such as meditation, which has been associated with a significant reduction in the risk of all-cause mortality, myocardial infarction, or stroke in patients with documented coronary heart disease.²

Acupuncture has proven to be effective in decreasing AF recurrences after electrical cardioversion in persistent AF and also in reducing the burden of AF among patients with paroxysmal AF.³ In addition, therapeutic hypnosis can lead to a statistically significant lower incidence of AF after coronary artery bypass graft surgery.⁴

Many patients with AF also suffer from chronic heart failure. Researchers have shown that patients who completed 12 weeks of tai chi training demonstrated a significantly improved heart failure-related quality of life, greater exercise tolerance (walked farther on a 6-minute test), and had greater decreases in blood levels of B-type natriuretic protein when compared to a usual-care group.⁵ In a larger follow-up study, the investigators found tai chi led to clinically significant improvements in quality of life.

These researchers believe that tai chi is a safe, adaptable form of aerobic exercise, can reduce stress and improve psychological well-being, improves breathing efficiency, may improve the confidence to exercise and motivate healthy behavior, and is associated with higher levels of social support.⁵ Importantly, about 90% of the participants in the heart failure and tai chi studies regularly came to the classes and practiced tai chi at home as well, which suggests that tai chi can be safely incorporated into regular activities, even for patients with chronic heart disease.

Other studies support including tai chi in the treatment of heart failure patients. A randomized controlled trial demonstrated that adding tai chi to endurance training for heart failure patients resulted in greater improvements in exercise tolerance (as assessed by the 6-minute walk test), systolic blood pressure, quality of life, and lower extremity strength, as compared to the control group.⁶

Although larger randomized controlled trials are needed to establish the relationship between adjunctive complementary and alternative therapies and AF, the current evidence suggests that these types of nonpharmacologic treatments may be safely incorporated into comprehensive management strategies for AF.

Published: 03/14/2013

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