Yoga vs regular exercise for atrial fibrillation: Design of the yoga-AF randomized controlled trial

Lifestyle modification is a key pillar of atrial fibrillation (AF) management. Yoga has beneficial effects on cardiovascular health and has shown promise as an intervention in AF. However, randomized data are absent.

To determine the effect of regular yoga on AF episodes and AF burden in people with paroxysmal or persistent AF over a 12-month period.

This is a randomized control trial of a yoga program in addition to standard care, compared to standard care alone in people with paroxysmal or persistent AF undergoing a rhythm control management strategy. 222 participants will be randomized 1:1 to the yoga intervention or control. Yoga will be conducted in studio and online with a target of at least 3 classes/week. Controls will be instructed to exercise for at least 150 minutes/week. Rhythm monitoring will be with implantable loop recorder, or ECG capable smartwatch with AF detection and twice daily ECGs. Autonomic metrics will be assessed in the laboratory by HRV, blood pressure variability and direct recordings of muscle sympathetic nerve activity. Following a 3-month training period, the dual primary endpoints of AF recurrence (time to recurrence, as defined by any sustained atrial tachyarrhythmia lasting >1 hour) and AF burden will be determined at 12 months.

This study aims to determine the impact of yoga on AF recurrence and burden in people with paroxysmal and persistent AF. Yoga may provide an effective noninvasive, nonpharmacologic lifestyle strategy in the management of AF.

The trial was preregistered with the Australian New Zealand Clinical Trials Registry (ACTRN12624000264583).