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Does Thermal Therapy Benefit Patients With Chronic Heart Failure?

      To the Editor: The recent symposium by Ramani et al
      • Ramani GV
      • Uber PA
      • Mehra MR
      Chronic heart failure: contemporary diagnosis and management.
      is a concisely written overview of the current management of chronic heart failure, surely to be of value to both the specialist and generalist. Absent from this review, however, is any mention of “Waon” or thermal therapy, likely in part because Waon therapy is not well known or appropriately used by most clinicians in the United States.
      First described by Tei et al
      • Tei C
      • Horikiri Y
      • Park JC
      • et al.
      Acute hemodynamic improvement by thermal vasodilation in congestive heart failure.
      in 1995, the methodology of thermal therapy and its benefits for patients with chronic heart failure (CHF) have been detailed extensively in the literature.
      • Kihara T
      • Biro S
      • Ikeda Y
      • et al.
      Effects of repeated sauna treatment on ventricular arrhythmias in patients with chronic heart failure.
      • Cider A
      • Sveälv BG
      • Täng MS
      • Schaufelberger M
      • Andersson B
      Immersion in warm water induces improvement in cardiac function in patients with chronic heart failure.
      • Cider A
      • Schaufelberger M
      • Sunnerhagen KS
      • Andersson B
      Hydrotherapy—a new approach to improve function in the older patient with chronic heart failure.
      • Kihara T
      • Biro S
      • Imamura M
      • et al.
      Repeated sauna treatment improves vascular endothelial and cardiac function in patients with chronic heart failure.
      These studies demonstrate improved New York Heart Association classification, decreased heart size, improved cardiac function, lowered incidence of arrhythmias, reduced brain natriuretic peptide and norepinephrine levels, and improvement in endothelial function. Furthermore, although not germane to this article, additional benefits have been described for thermal therapy in several other diseases, including Sjögren syndrome, peripheral vascular disease, pulmonary hypertension, and fibromyalgia.
      It is interesting to speculate about reasons for the failure to use this therapeutic modality in this country, including absence of any financial incentives, but clearly a deficiency in knowledge of Waon therapy plays an important role. A brief discussion of thermal therapy in CHF would have been appropriate in this symposium in Mayo Clinic Proceedings, especially because Tei's original research into this modality was done while he was an international fellow at Mayo Clinic.

      REFERENCES

        • Ramani GV
        • Uber PA
        • Mehra MR
        Chronic heart failure: contemporary diagnosis and management.
        Mayo Clin Proc. 2010; 85: 180-195
        • Tei C
        • Horikiri Y
        • Park JC
        • et al.
        Acute hemodynamic improvement by thermal vasodilation in congestive heart failure.
        Circulation. 1995; 91: 2582-2590
        • Kihara T
        • Biro S
        • Ikeda Y
        • et al.
        Effects of repeated sauna treatment on ventricular arrhythmias in patients with chronic heart failure.
        Circ J. 2004; 68: 1146-1151
        • Cider A
        • Sveälv BG
        • Täng MS
        • Schaufelberger M
        • Andersson B
        Immersion in warm water induces improvement in cardiac function in patients with chronic heart failure.
        Eur J Heart Fail. 2006; 8: 308-313
        • Cider A
        • Schaufelberger M
        • Sunnerhagen KS
        • Andersson B
        Hydrotherapy—a new approach to improve function in the older patient with chronic heart failure.
        Eur J Heart Fail. 2003; 5: 527-535
        • Kihara T
        • Biro S
        • Imamura M
        • et al.
        Repeated sauna treatment improves vascular endothelial and cardiac function in patients with chronic heart failure.
        J Am Coll Cardiol. 2002; 39: 754-759

      Linked Article

      • Does Thermal Therapy Benefit Patients With Chronic Heart Failure?–Reply–I
        Mayo Clinic ProceedingsVol. 85Issue 7
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          Dr Hanlon raises an interesting and thought-provoking point regarding the beneficial effects of Waon therapy (soothing warm therapy) in patients with CHF. This therapy, which uses repeated 15-minute treatments in a 60°C infrared sauna, has been reported in small studies to improve left ventricular systolic function and favorably affect natriuretic peptide levels.1 Several behavioral and nontraditional approaches have been studied in CHF, including conscious breath control with extended expiration and reduced respiratory rate,2,3 enhanced external counterpulsation,4 and warm water immersion.
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