Psychosocial and cardiac outcomes of yoga for ICD patients: a randomized clinical control trial.

BACKGROUND: Because as many as 46% of implantable cardioverter defibrillator (ICD) patients experience clinical symptoms of shock anxiety, this randomized controlled study evaluated the efficacy of adapted yoga (vs usual care) in reducing clinical psychosocial risks shown to impact morbidity and mortality in ICD recipients. METHODS: Forty-six participants were randomized to a control group or an 8-week adapted yoga group that followed a standardized protocol with weekly classes and home practice. Medical and psychosocial data were collected at baseline and follow-up, then compared and analyzed. RESULTS: Total shock anxiety decreased for the yoga group and increased for the control group, t(4.43, 36), P < 0.0001, with significant differences between these changes. Similarly, consequential anxiety decreased for the yoga group but increased for the control group t(2.86,36) P = 0.007. Compared to the control, the yoga group had greater overall self-compassion, t(-2.84,37), P = 0.007, and greater mindfulness, t(-2.10,37) P = 0.04, at the end of the study. Exploratory analyses utilizing a linear model (R(2) = 0.98) of observed device-treated ventricular (DTV) events revealed that the expected number of DTV events in the yoga group was significantly lower than in the control group (P < 0.0001). Compared to the control, the yoga group had a 32% lower risk of experiencing device-related firings at end of follow-up. CONCLUSIONS: Our study demonstrated psychosocial benefits from a program of adapted yoga (vs usual care) for ICD recipients. These data support continued research to better understand the role of complementary medicine to address ICD-specific stress in cardiac outcomes.

2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure.

Cardiac physiologic pacing (CPP), encompassing cardiac resynchronization therapy (CRT) and conduction system pacing (CSP), has emerged as a pacing therapy strategy that may mitigate or prevent the development of heart failure (HF) in patients with ventricular dyssynchrony or pacing-induced cardiomyopathy. This clinical practice guideline is intended to provide guidance on indications for CRT for HF therapy and CPP in patients with pacemaker indications or HF, patient selection, pre-procedure evaluation and preparation, implant procedure management, follow-up evaluation and optimization of CPP response, and use in pediatric populations. Gaps in knowledge, pointing to new directions for future research, are also identified.

2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure.

Cardiac physiologic pacing (CPP), encompassing cardiac resynchronization therapy (CRT) and conduction system pacing (CSP), has emerged as a pacing therapy strategy that may mitigate or prevent the development of heart failure (HF) in patients with ventricular dyssynchrony or pacing-induced cardiomyopathy. This clinical practice guideline is intended to provide guidance on indications for CRT for HF therapy and CPP in patients with pacemaker indications or HF, patient selection, pre-procedure evaluation and preparation, implant procedure management, follow-up evaluation and optimization of CPP response, and use in pediatric populations. Gaps in knowledge, pointing to new directions for future research, are also identified.

Cardiac resynchronization: a brief synopsis part I: patient selection and results from clinical trials.

Heart failure continues to affect large populations within the industrialized nations. Previous therapies have been directed at increasing myocardial contractility or decreasing vascular resistance but have not addressed the mechanical dysfunction within certain subpopulations with heart failure. Biventricular pacing has been shown to improve both acute hemodynamic parameters and long-term functional capacity in patients with ventricular dysynchrony and suffering from severe heart failure. From this data, the therapy is indicated for use in patients with depressed ejection fraction, bundle branch block, and either NYHA class III or class IV heart failure, regardless of whether or not there is a separate indication for ICD placement. Recent studies suggest that biventricular pacing may remodel the failing heart. Future studies could expand the previously mentioned indications to patients suffering from mild symptoms of heart failure. This article reviews the current demographics involved within this population, the acute hemodynamic benefits experienced from biventricular pacing, the long term function benefits experienced from the therapy, and other possible benefits from the therapy.

Cardiac resynchronization: a brief synopsis part II: implant and followup methodology.

The following sections detail the medical approach of the three implanters within our group from 75 resynchronization implants as well as the technical field support experience from over 300 resynchronization implants.