Effect of Yoga on Early Recurrence of Atrial Tachyarrhythmia after Atrial Fibrillation Ablation

ABSTRACT
Background: Atrial fibrillation (AF) is the most common sustained cardiac rhythm disturbance, increasing in prevalence with age. Today, medical treatment involving catheter ablation is the well-accepted management strategy; however, failure of this therapy is common, with only two-thirds or less of the patients treated remaining free of AF on long-term follow-up. Given the role that stress, anxiety, inflammation, and autonomic nervous system imbalance plays in AF, the complementary health-enhancing therapy of yoga could potentially prevent episodes of AF. Although, to date, two studies have assessed the impact of yoga on paroxysmal AF, no studies have investigated the effect of yoga on early recurrence of atrial tachyarrhythmia (ERAT) after AF ablation.
Objective: The two specific aims for this study were: (1) to examine the feasibility and acceptability of a Viniyoga intervention for individuals with AF and (2) to test whether or not a 6-week Viniyoga intervention in persons age 18 to 65 years with paroxysmal or persistent AF prior to ablation will decrease AF symptoms, stress, depression, anxiety, prevent ERAT after AF ablation, and improve overall health-related quality of life (QOL) during the 6-month post-ablation period if these participants continued to practice yoga post-ablation at least twice a week for 50 minutes. A secondary aim was to capture all the participants’ perceptions of health-related QOL, using semi-structured interviews, and for the yoga intervention group participants, their experiences with yoga as well.
Design and Methods: A sequential mixed methods, prospective, quasi-experimental, two-group design informed by a psychoneuroimmunology theoretical framework guided the study design to investigate the effect of a twice-weekly 6-week Viniyoga intervention and continued practice of yoga at home in prevention of ERAT after AF ablation. Self-report questionnaires were completed at 8 different time points, including baseline and at the 6-month post-AF ablation time period. All participants participated in a semi-structured interview during their 6-month post-ablation clinic visit.
Results: The recruitment rate for the yoga intervention plus usual care (YI) group was very low at 16.67% and 50% for the usual care alone (UC) group, with recruitment for the UC group having been stopped because of less recruitment to the YI group. A total of 4 UC group participants and 2 participants in the YI group completed the study. Two major reasons for participants declining participation in the study were travel distance and challenges in attending twice-weekly YI sessions. Other reasons included current practice of yoga or mindfulness meditation, lack of a smart phone or iPad to download the AlivecorTM app, and questions about the affiliation of yoga with a religion that the participants did not practice. No statistical significance was achieved for any of the study outcome measures given the small sample size, although clinically meaningful improvements were noted in the Atrial Fibrillation Effect on QualiTy-of-Life questionnaire overall score and symptom score in the YI group compared with the UC group participants. The study also showed that ERAT in the two YI participants was 0% but it was 75% in the four UC group participants. Minimal decrease in stress, depression, and anxiety scores were noted, although qualitative data analysis showed that the participants identified stress, depression, and anxiety as triggers and manifestations of their AF. The reason for no significant change in the anxiety scores may be related to the fact that a new diagnosis of AF is compounded with much anxiety about the disease course, and at post-ablation these participants continued to be worried about recurrences, with this impacting their QOL.
Conclusion: This study did not show any statistical significance in the outcome measures, which may be because of the small sample size, but it did show clinically meaningful improvements in a few of the study outcomes as described above. These preliminary findings support the need for future randomized controlled studies to determine the impact of yoga on prevention of recurrent atrial arrhythmias.