Friday Q&A: Yoga and Pacemakers

Q: I am a yoga practitioner and a teacher of active classes, and have been for 20 years. I am 64. Four years ago, I had a pacemaker put in to correct sick sinus syndrome, which is to say I began randomly fainting because my heart hesitated too long between beats - for no identifiable reason. All other aspects of my heart health and general health are excellent. I returned to my asana practice slowly as I learned to keep space between the collarbone and first rib where the wire is inserted in the subclavanian artery so as not to damage or wear it out prematurely. Having been certified in Anusara, I exaggerated the action of 'shoulder loop', keeping my side body long and my inner body bright. I have not found any other practitioners or therapists, nor have I found any teacher or doctor other than Dr. Carrie Demers who would even address this. Dr. Deemers suggested nadi sodana and agni sara as ways to vitalize the first chakra energy and therefore increase energy upward.

Does anyone on your team have insight or suggestions? I can't be the only yogi with a pacemaker, can I? My aim is to lessen the amount of times my body turns to this back-up device and to put off the eventual need for replacement of the battery and/or wires - which has to be down for everyone sooner or later.

A: This is an intriguing question. To date, there are no specific studies looking at sick sinus syndrome and yoga to help guide us. And none of our staff are cardiac medical specialists, so we are not able to give the kind of specific, scientifically grounded advice our reader may be seeking. The steps the writer has already taken to keep space between the collar bone and first rib appear to be anatomically sound and may indeed lead to keeping the pacemaker in working order longer than poor postural habits might do. General attention to Mountain pose and other upright poses that encourage a broad, open upper chest region could help this work with the Anusara chest loop.

Because the sick sinus syndrome is not very common, I have included a brief definition found on the Mayo Clinic website:

 “Sick sinus syndrome is the name for a group of heart rhythm problems (arrhythmias) in which the sinus node — the heart's natural pacemaker — doesn't work properly.” 

See the Mayo website here for further information.

The result of a natural pacemaker that does not work properly can be a slower heart rate, a faster heart rate, long pauses in heart rhythm, or a combination of these variations.  Once the condition is treated and artificial pacemaker is put in place, these variations become less dangerous.

Although I could not find specifics on the effects of stress for sick sinus syndrome, stress can definitely have a negative effect on general heart health. Yoga has been found to be helpful with other heart conditions, even though sick sinus syndrome has not been yet studied. And because yoga techniques can help lower stress responses in regular practitioners, simply doing a balanced practice several times a day, if approved by your cardiologist, could be of overall help for your heart health. In addition, practices that are deeply relaxing for the body and mind, such as restorative practice and guided meditations like yoga nidra would also be helpful.

Caution should be practiced with pranayama techniques in which the breath is held at the beginning or end of an inhale or exhale, as these could either stimulate the heart rate to drop too low or surge too high.  In particular, if one takes a full breath in and then retains or holds it for a number of seconds, it could cause a sudden drop in heart rate if not performed properly. In the medical world, this is known as a Valsalva maneuver.  And although it is used in medical settings to treat abnormally fast heart rates and even as a diagnostic tool, a pranayama practitioner would not necessarily want to invoke this response unawares. 

Balanced alternate nostril breathing, nadi shodhana, without retention, would therefore  likely be neutral in effect on the heart, and therefore safe to practice. Agni sara, since it involves breath retention at the end of an exhale, could be a bit more tricky. I’d recommend finding a pranayama teacher with many years of experience to work with more closely to support a regular heart rate. Please keep us posted on practices you find helpful down the road!

—Baxter