Use of HRV in the Acupuncture Clinic: Pitfalls and Promise
This article looks at HRV and whether it really is a valid reflection of autonomic balance. It seems that they mostly are concerning themselves with long term HRV analysis, ie over hours and days. But it can be helpful to question assumptions in the hope that by robust analysis of HRV, we will get better, higher fidelity readings. In particular, they question the use of LF and HF as the gold standard for HRV readings. I’ve been looking at that too, over the years. I’ve been looking in depth at not only nonlinear measures, but also combing nonlinear and frequency measures in an attempt to pick up more nuances signals. And also, as in this patient, looking at an overall RMSSD over time. I’m going to copy their conclusion in its entirety.
This paper described the major pitfalls of the assessment of autonomic function by HRV. Overall, HRV tends to be used beyond the limit of its capacity as a quantitative measure of autonomic function. Particularly, the framework to associate the HRV frequency components (LF and HF) with the divisions of the autonomic nervous system (sympathetic and parasympathetic) is already too simplistic, and it is the major cause of the pitfalls.
On the other hand, even if HRV is a limited measure of autonomic functions, it is still a fact that HRV is there. Except for some exception such as HRF [heart rate fragmentation], HRV is thought to originate from the brain and to transfer to the heart through the autonomic nervous system. Like the radio that extracts information from radio waves modulated by the broadcasting station, HRV analysis can intercept the information for circulatory regulation generated by the brain. We will be able to expect the continued development of HRV researches by aiming for a faithful and unbiased extraction of the information contained in HRV beyond the classic framework of LF and HF.
- Department of Medical Education, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho Mizuho-ku, Nagoya, 467-8602, Japan. firstname.lastname@example.org.
- Department of Medical Education, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho Mizuho-ku, Nagoya, 467-8602, Japan.
Although analysis of heart rate variability is widely used for the assessment of autonomic function, its fundamental framework linking low-frequency and high-frequency components of heart rate variability with sympathetic and parasympathetic autonomic divisions has developed in the 1980s. This simplified framework is no longer able to deal with much evidence about heart rate variability accumulated over the past half-century. This review addresses the pitfalls caused by the old framework and discusses the points that need attention in autonomic assessment by heart rate variability.