HRV Analysis in the Acupuncture Clinic: Feasibility and Effectiveness

I had to rework my abstract for the upcoming (click on the logo for a link)
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 Rate Variability Analysis in the Acupuncture Clinic: Correlation with Clinical Outcomes

Kristen Sparrow, MD

Private Practice

San Francisco, California

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

 In contrast to the research setting, there are time and efficiency constraints in the private acupuncture practice. In addition there can be monitoring artifacts which make frequency and time domain HRV analysis unreliable.  The author hypothesizes that analysis using nonlinear HRV analysis in addition to the aforementioned analysis methods will give a more sensitive and dependable evaluation of the patients’ autonomic state and show a more consistent correlation with clinical outcomes. The ultimate goal is to use HRV as an additional feedback in the clinic to achieve better results and hence, better outcomes.

Objective:

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

Design, Setting, and Patients:  Case study of 20 patients representing 80 treatment sessions. The presenting diagnoses were varied including hypertension(3), low back pain/sciatica (3), headache/migraine(5), depression/anxiety(4), peripheral neuropathy (2), allergy (1), IBS(1), PCOS (1).

Intervention: All patients received body acupuncture according Traditional Chinese Medicine principles. Electro-acupuncture was used if following a protocol (PCOS), or if manual acupuncture was not proving effective.  HRV data was collected after needle placement for 20 minutes, and analyzed after treatment. 

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

1. Time series: pnn50 %

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

3. Nonlinear results:  Poincaré Plots (SD1/SD2) and Sample entropy

Results:

Patients who responded to their acupuncture treatment tended to exhibit a decrease in LFR/HFR in the segment “a,” compared to “b” by at least 30% and/or an increase from “a” to “b” in the nonlinear measurement SD1/SD2 by at least 20%.

 Non-responders, or patients who were aggravated by a particular treatment tended to show no change or an increase in their LFR/HFR from “a” to “b”   and a decrease in their SD1/SD2 from “a” to “b.”

Conclusions: In this study the correlation between increased HRV during acupuncture treatment and positive response to acupuncture was supported. Use of nonlinear analysis in addition to frequency domain measures added to the sensitivity of HRV outcome measures.