PO-05-235 MANAGEMENT OF REFLEX VASOVAGAL SYNCOPE (VVS) WITH A PROTOCOL INCORPORATING “TADASANA” YOGA MANEUVER

Abstract

VVS is a common clinical problem with no satisfactory standard treatment.Yoga is being used to treat VVS and effectiveness of Tadasana has been shown in a case-control pilot study To assess efficacy of a protocol incorporating "Tadasana"- A yoga maneuver in achieving freedom from clinical symptoms and quality of life in patients with VVS Patients with at least 2 episodes of syncope/Near syncope suggestive of VVS in the last 3 months and having positive Tilt test were included All patients were treated with a systematic protocol of reassurance, instructions on maintaining adequate hydration, syncope avoidance, physical maneuvers and systematic teaching of "Tadasana " maneuver of Yoga(Fig 1 A).This yoga maneuver was instructed to be repeated for 8 – 12 cycles while consciously breathing in a relaxed manner, undertaken once a day. Fludrocortisone and Midodrine were initiated if symptoms persisted. Pacemaker was implanted as per guidelines. Patients were regularly followed up by telephone for symptom assessment , and confirming adherence to treatment protocol. Syncope functional status questionnaires (QOL, Fear score and syncope dysfunctional status- SDS) were administered at time of inclusion in study and at 1 year of follow up There were 175 patients ( 116 M & 59 F, Mean age 50 ± 20 years), Patients excluded from analysis were 18. (death-1/lack of adherence-7 / voluntary withdrawal from study-10. Comorbidities were HTN - 65, DM- 33, Hypothyroid - 5, CAD- 7, All had structurally normal hearts (Mean LVEF=62 ± 5%.). Fludrocortisone was used in 7 patients (4%) and midodrine in 1(0.6%). 2 patients needed permanant pacemeker implantation.At a mean follow up of 22 ± 14 months, there was decrement in mean- Total events: 4.77 ± 7 to 0.26±1.5,P <0.001 Syncope: 2± 2 to 0.07 ± 0.04P <0.001, Near syncope:2.8 ± 7 to 0.2 ± 1.4 P <0.001 (Figure 1 B). At 1 year favourable improvent were seen in QOL (25±13 to1±6,P <0.001 ), Fear score (53 ±24 to 38 ±17P <0.001, ) and SDS (39±15 to11 ± 10, P <0.001). A protocol incorporating yoga manuver "Tadasana" is effective in achieving reduction in syncopal and near sycopal episodes and leading to an improvement in quality of life in patients with VVS.