Heart Rate Variability Biofeedback in Patients With Paroxysmal Atrial Fibrillation

Document Type : Original Article


1 Department of Interventional Cardiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

2 Department of Medical Engineering, Science and Research Branch, Islamic Azad University, Tehran, IR Iran.

3 Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.


Background: Heart rate variability biofeedback (HRVB) is an approach to ameliorate conditions in which HRV is relatively low. Some patients with paroxysmal atrial fibrillation (AF) show increased adrenergic tone in their paroxysms.
Methods: We conducted this study to determine the effects of HRVB on patients with paroxysmal AF. Thirty-one patients (11 women) at an average age of 58±10 years (38–79 y) with paroxysmal AF were included in the study. Of these, 19% had AF during exertion; 29% during rest; and in the remaining 52%, episodes were mixed. A 24-hour ambulatory Holter monitoring was done before and after 5 weeks of biofeedback training.
Results: The interpretation of Holter monitoring disclosed that high frequency changed significantly after HRVB. Clinically, 12 patients felt better, 4 patients felt worse, and 15 patients felt no obvious change. Low frequency and more importantly very low frequency decreased, which was due to a decrement in sympathetic tone.
Conclusions: HRVB in patients with adrenergic AF might reduce their episodes of paroxysmal AF and help them feel better. (Iranian Heart Journal 2021; 22(2): 68-76)


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