HRV Analysis in the Acupuncture Clinic: Feasibility and Effectiveness

So I’ll go ahead and post it here. I’ve been working on my poster presentation and I will probably try to illustrate how I use the HRV to help guide my treatments rather than try to convince anyone of the scientific validity of the approach. Once I get it all together, I’ll post it here. The committee wanted my abstract not to be so, er, abstract. So I included the conditions treated and type of acupuncture used. But since it had to be under 2,300 characters, I ended up changing it a fair amount. (For info on my practice, please click here.)

Heart RateVariability Analysis in the Acupuncture Clinic: Correlation with ClinicalOutcomes

Kristen Sparrow, MD

Private Practice

San Francisco, California

Background: HeartRate Variability (HRV) analysis is a non-invasive method of assessing autonomictone and has been studied in conjunction with acupuncture in a number ofcontexts. Acupuncture can lower sympathetic tone and enhance vagal activity,i.e decrease the stress reponse.

In contrast to the research setting, there aretime and efficiency constraints in the private acupuncture practice. Inaddition there can be monitoring artifacts which make frequency and time domainHRV analysis unreliable. The authorhypothesizes that analysis using nonlinear HRV analysis in addition to theaforementioned analysis methods will give a more sensitive and dependableevaluation of the patients’ autonomic state and show a more consistentcorrelation with clinical outcomes. The ultimate goal is to use HRV as anadditional feedback in the clinic to achieve better results and hence, betteroutcomes.

Objective:

To correlate patient’s responses to acupuncturetreatment with their intra- treatment HRV measurements across time, frequencyand nonlinear domains.

Design, Setting, and Patients: Case study of20 patients representing 80 treatment sessions. The presenting diagnoses werevaried including hypertension(3), low back pain/sciatica (3),headache/migraine(5), depression/anxiety(4), peripheral neuropathy (2), allergy(1), IBS(1), PCOS (1).

Intervention: Allpatients received body acupuncture according Traditional Chinese Medicineprinciples. Electro-acupuncture was used if following a protocol (PCOS), or ifmanual acupuncture was not proving effective. HRV data was collected after needle placementfor 20 minutes, and analyzed after treatment.

Main Outcome Measure: Patients were assessed by symptom resolution. TheirHRV data were compared for the time frames “a”(60 to 360 sec) and “b” (360 to 660sec) using Kubios shareware for:

1. Timeseries: pnn50 %

2.Frequency Domain: FFT (LFR/HFR) ratios and HFR%

3. Nonlinearresults: Poincaré Plots (SD1/SD2) andSample entropy

Results:

Patients who responded to their acupuncture treatmenttended to exhibit a decrease in LFR/HFR in the segment “a,” compared to “b” byat least 30% and/or an increase from “a”to “b” in the nonlinear measurementSD1/SD2 by at least 20%.

Non-responders,or patients who were aggravated by a particular treatment tended to show nochange or an increase in their LFR/HFR from “a” to “b” and a decrease in their SD1/SD2 from “a” to “b.”

Conclusions: Inthis study the correlation between increased HRV during acupuncture treatmentand positive response to acupuncture was supported. Use of nonlinear analysisin addition to frequency domain measures added to the sensitivity of HRVoutcome measures.