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Friday Q A Implantable Cardioverter Defibrillators ICD and Yoga

USNS Comfort by Marie Lossky
(@Marie.Lossky on Instagram)

Q: I recently had an Implantable Cardioverter Defibrillator (ICD) installed (mid-December). And now I'm trying to work out my yoga practice (I've had a yoga practice for almost 30 years, currently almost entirely Iyengar)—trying to figure out what I have to give up. I don't do Urdhva Dhanurasana and Headstand (this one because of slight carotid stenosis). I'm 72, and except for the heart issues my health is good.

I’ve been advised no Chaturanga because of possible engagement of chest muscles (don't want to stress those wires!). My cardio electrophysiologist says stretching is okay – but weight-bearing engagement of the chest is very bad. 

I'll be returning to class in a week or so. My teacher is fabulous (a student of Donald Moyer), but she's never had experience with someone with an ICD. We're going to learn together. 

Big question: What about Handstand? It's my favorite pose—maybe the best moment of my day. My brilliant electrician is worried about it—thinking it might be too much chest engagement. I see it more as bone, not so much muscle. I don't want to be stupid about it, though. 

A: Implantable Cardioverter Defibrillators (ICD units) are very small devices that work like the large paddled defibrillators used in hospitals, ambulances, and many public spaces. They shock a heart that is either not beating at all or is in a life-threatening rhythm back to a normal rhythm to prevent heart attack and sudden cardiac death. 

So for people who have documented dangerous heart rhythms, Implantable Cardioverter Defibrillators can prevent sudden death! The small unit is placed just under the skin on the front of the chest, and a wire attached to the unit is threaded into the heart muscle. It is this wire that is vulnerable to breaking or getting dislodged.

As always with questions that I get that are about a particular illness or disease, I cannot directly give specific advice to you about your asana practice and your ICD without working with you directly. However, there are a few aspects of this inquiry I would like to address. If your doctor (a specialist in the electrical systems of the heart and these devices) is correct that you run the risk of breaking the wire that runs from the implanted defibrillator to the heart, rendering it useless if you do a lot of weight bearing exercise on the hands that engage the chest muscles strongly, I’d take that to heart (sorry about the pun!). I recommend that you get a bit more information from your specialist physician to see if there is any leeway to do short holds or dynamic variations in certain poses versus simply not doing any weight-bearing engagement of the chest.

And if indeed dynamic or short and long holds are out, then you want to look closely at the poses you normally do and remove those that put you at risk for damaging your unit. That would essentially include all arm balances (including, for example, Crow pose, and yes, Handstand, Forearm Balance, Headstand, etc.) and other poses that engage the front chest muscles such as Plank, Forearm Plank, Side Plank, and arguably even Downward-Facing Dog, Upward-Facing Dog, and Bow pose.

I personally would also eliminate Shoulderstand because the position of the arms could put excessive stress on front chest tissues. Try safer substitutes for all these poses. For example, for the inversions, you can substitute safer inverted poses, such as Legs Up the Wall pose or using a Headstander device at the wall. And for Downward-Facing Dog pose, you could practice Half Downward-Facing Dog at the wall and for Upward Facing Dog pose you could practice Locust Pose or Cobra pose with arms bent and very little weight on the hands. 

Even though you may need to eliminate to some poses from your repertoire, I recommend that you continue regularly practicing a well-rounded practice. You will still reap all the physical benefits of strength, flexibility, agility, and balance that a balanced asana practice provides.

And if you are not already practicing stress management and equanimity practices, you should consider adding them to your regular routines. 

Stress management is important for those with ICD units because a common problem for people who have them is anticipatory anxiety over if and when the unit might discharge to reset the heart’s rhythm (shock you!). You can imagine how disturbing it might be to have a strong electrical discharge/shock suddenly sent into your heart without any distinct warning that it’s coming. In fact, anxiety and depression are reported in about a third of all people who have ICD’s placed. A 2014 study Psychosocial and Cardiac Outcomes of Yoga for ICD Patients: A Randomized Clinical Control Trial that looked at the benefit of a regular yoga practice on this anxiety issue found that those in the study group who did yoga for eight weeks experienced a decrease in shock-related anxiety and actually had fewer episodes of the ICD units firing off, lowered by about 30%.

And cultivating equanimity can help with you with making decisions about letting go of something you used to be able to do. As we have written about many times before, these sorts of changes and loss are inevitable. But is healthy and reasonable to experience sadness over or grieve the loss of something you used to be able to do, that you may have enjoyed and that even gave you a sense of accomplishment and competence. Using yoga to support equanimity, for example, practicing calming pranayama and meditating regularly, will help you emotionally rebalance more rapidly and have a healthier perspective on the relative importance of the loss. And this process—which we are likely to experience many times in our lives as we age—also opens up the door to remaining curious about what you can still do and what new things you can learn. 

Not sure what to do to cultivate equanimity? Check out Nina’s excellent post with many suggestions: 7 Ways to Cultivate Equanimity with Yoga.

—Baxter

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