Editorials
Vol. 21 No. 1 (2025)
A practice teaching from GIMSI (Italian Multidisciplinary Syncope Group) 2025: yoga as a treatment for recurrent vasovagal syncope
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 10 March 2025
370
Views
370
Downloads
Authors
The XII Italian National Congress of GIMSI (Italian Multidisciplinary Syncope Group) has taken place in Milan on February 6-7, 2025. This report summarizes a practice teaching from the congress regarding the role of yoga and physical exercise in managing Vasovagal Syncope (VVS).
VVS is a very common clinical condition with an estimated lifetime prevalence of 35%1 and a frequent reason for emergency department visits.2 Although VVS is not associated with an increased rate of mortality, there is a significant deterioration in the Quality Of Life (QoL) in conjunction with the severity and frequency of recurrences.3
Pharmacological and non-pharmacological therapies, such as elastic compression stocking, dietary modification with oral rehydration salts and increased salt intake, tilt training (also known as standing training), and physical counter-pressure manoeuvres, have demonstrated only limited and modest efficacy, which can be frustrating for both patients and clinicians.4,5 There is no single uniformly accepted protocol to prevent VVS recurrences and some patients with recurrent syncope end up being submitted to procedures, such as pacemaker implantation or cardioneuroablation. The latter is showing promising results, but it is an invasive manoeuvre, and its long-term effects are unknown.6 [...]
Downloads
Download data is not yet available.
Citations
Ganzeboom KS, Mairuhu G, Reitsma JB, et al. Lifetime cumulative incidence of syncope in the general population: a study of 549 Dutch subjects aged 35-60 years. J Cardiovasc Electrophysiol 2006;17:1172-6. DOI: https://doi.org/10.1111/j.1540-8167.2006.00595.x
van Dijk N, Boer KR, Colman N, et al. High diagnostic yield and accuracy of history, physical examination, and ECG in patients with transient loss of consciousness in FAST: the Fainting Assessment study. J Cardiovasc Electrophysiol 2008;19:48-55. DOI: https://doi.org/10.1111/j.1540-8167.2007.00984.x
Bartoletti A, Fabiani P, Bagnoli L, et al. Physical injuries caused by a transient loss of consciousness: main clinical characteristics of patients and diagnostic contribution of carotid sinus massage. Eur Heart J 2008;29:618-24. DOI: https://doi.org/10.1093/eurheartj/ehm563
Shen WK, Sheldon RS, Benditt DG, et al. 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm 2017;14:e155-e217.
Kuriachan V, Sheldon RS, Platonov M. Evidence-based treatment for vasovagal syncope. Heart Rhythm 2008;5:1609–14 DOI: https://doi.org/10.1016/j.hrthm.2008.08.023
Pachon JC, Pachon EI, Pachon JC, et al. “Cardioneuroablation”—new treatment for neurocardiogenic syncope, functional AV block and sinus dysfunction using catheter RF‐ablation. Europace 2005;7:1‐13 DOI: https://doi.org/10.1016/j.eupc.2004.10.003
Alharbi A, Shah M, Gupta M, et al. The efficacy of non-pharmacological and non-pacing therapies in preventing vasovagal syncope: Tilt training, physical counter pressure maneuvers, and yoga - A systematic review and meta-analysis. Auton Neurosci 2024;251:103144. DOI: https://doi.org/10.1016/j.autneu.2023.103144
Ghati N, Killa AK, Sharma G, et al. A randomized trial of the immediate effect of bee-humming breathing exercise on blood pressure and heart rate variability in patients with essential hypertension. Explore (NY) 2021;17:312-9. DOI: https://doi.org/10.1016/j.explore.2020.03.009
Hagins M, States R, Selfe T, Innes K. Effectiveness of yoga for hypertension: sys tematic review and meta-analysis. Evid Based Complement Alternat Med 2013;2013:1–13. DOI: https://doi.org/10.1155/2013/649836
Lakkireddy D, Atkins D, Pillarisetti J, et al. Effect of yoga on arrhythmia burden, anxiety, depression, and quality of life in paroxysmal atrial fibrillation: the YOGA My Heart Study. J Am Coll Cardiol 2013;61:1177-82. DOI: https://doi.org/10.1016/j.jacc.2012.11.060
Gomes-Neto M, Rodrigues ES Jr, Silva WM Jr, Carvalho VO. Effects of yoga in patients with chronic heart failure: a meta-analysis. Arq Bras Cardiol 2014;103:433–9. DOI: https://doi.org/10.5935/abc.20140149
Prabhakaran D, Chandrasekaran AM, Singh K, et al. Yoga-based cardiac rehabilitation after acute myocardial infarction: a randomized trial. J Am Coll Cardiol 2020;75:1551-61. DOI: https://doi.org/10.1016/j.jacc.2020.01.050
Feuerstein G. The yoga tradition: its history, literature, philosophy, and practice. Prescott, AZ: Hohm Press; 1998
Ross A, Thomas S. The health benefits of yoga and exercise: a review of comparison studies. J Altern Complement Med 2010;16:3-12. DOI: https://doi.org/10.1089/acm.2009.0044
Streeter CC, et al. Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder. Med Hypotheses 2012;78:571-9. DOI: https://doi.org/10.1016/j.mehy.2012.01.021
Abdelazeem B, Abbas KS, Manasrah N, et al. Yoga as a treatment for vasovagal syncope: A systematic review and meta-analysis. Complement Ther Clin Pract 2022;48:101579. DOI: https://doi.org/10.1016/j.ctcp.2022.101579
Gunda S, Kanmanthareddy A, Atkins D, et al. Role of yoga as an adjunctive therapy in patients with neurocardiogenic syncope: a pilot study. J Interv Card Electrophysiol 2015;43:105-10. DOI: https://doi.org/10.1007/s10840-015-9996-1
Shenthar J, Gangwar RS, Banavalikar B, et al. A randomized study of yoga therapy for the prevention of recurrent reflex vasovagal syncope. Europace 2021;23:1479-86. DOI: https://doi.org/10.1093/europace/euab054
Sharma G, Ramakumar V, Sharique M, et al. Effect of yoga on clinical outcomes and quality of life in patients with vasovagal syncope (LIVE-Yoga). JACC Clin Electrophysiol 2022;8:141-9. DOI: https://doi.org/10.1016/j.jacep.2021.09.007
Rao BH, Surath M. "Tadasana" yoga maneuver for preventing vasovagal syncope recurrences: a pilot study. JACC Clin Electrophysiol 2022;8:253-4. DOI: https://doi.org/10.1016/j.jacep.2021.12.007
Udupa K, Sathyaprabha TN. Influence of yoga on the autonomic nervous system. In S Telles, N Singh (eds). Research-Based Perspectives on the Psychophysiology of Yoga. Hershey PA, USA: IGI Global, 2018. pp. 67–85. DOI: https://doi.org/10.4018/978-1-5225-2788-6.ch005
Govindaraj R, Karmani S, Varambally S, Gangadhar BN. Yoga and physical exercise - a review and comparison. Int Rev Psychiatry 2016;28:242-53. DOI: https://doi.org/10.3109/09540261.2016.1160878
Pournazari P, Sahota I, Sheldon R. High remission rates in vasovagal syncope: systematic review and meta-analysis of observational and randomized studies. JACC Clin Electrophysiol 2017;3:384-92. DOI: https://doi.org/10.1016/j.jacep.2016.10.012
Brignole M, Russo V, Arabia F, et al. Cardiac pacing in severe recurrent reflex syncope and tilt‐induced asystole. Eur Heart J 2021;42:508‐16 DOI: https://doi.org/10.1093/eurheartj/ehaa936
Sheldon RS, Raj SR. Treating syncope without drugs: Standing still, exercising hard, or simply the "expert's touch"? J Cardiovasc Electrophysiol 2022;33:1871-3. DOI: https://doi.org/10.1111/jce.15576
How to Cite
A practice teaching from GIMSI (Italian Multidisciplinary Syncope Group) 2025: yoga as a treatment for recurrent vasovagal syncope. (2025). Emergency Care Journal, 21(1). https://doi.org/10.4081/ecj.2025.13810
Copyright (c) 2025 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
