Iranian Heart Journal

Iranian Heart Journal

Heart Rate Variability Biofeedback in Patients With Paroxysmal Atrial Fibrillation

Document Type : Original Article

Authors
Mohammad Ali Sadr-Ameli 1
Parisa Izadpanah 1
Sadaf Sadr-Ameli 2
Keivan Maghooli 2
Shabnam Madadi 3
1 Department of Interventional Cardiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
2 Department of Medical Engineering, Science and Research Branch, Islamic Azad University, Tehran, IR Iran.
3 Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Abstract
Background: Heart rate variability biofeedback (HRVB) is an approach to ameliorate conditions in which HRV is relatively low. Some patients with paroxysmal atrial fibrillation (AF) show increased adrenergic tone in their paroxysms.
 
Methods: We conducted this study to determine the effects of HRVB on patients with paroxysmal AF. Thirty-one patients (11 women) at an average age of 58±10 years (38–79 y) with paroxysmal AF were included in the study. Of these, 19% had AF during exertion; 29% during rest; and in the remaining 52%, episodes were mixed. A 24-hour ambulatory Holter monitoring was done before and after 5 weeks of biofeedback training.
 
Results: The interpretation of Holter monitoring disclosed that high frequency changed significantly after HRVB. Clinically, 12 patients felt better, 4 patients felt worse, and 15 patients felt no obvious change. Low frequency and more importantly very low frequency decreased, which was due to a decrement in sympathetic tone.
 
Conclusions: HRVB in patients with adrenergic AF might reduce their episodes of paroxysmal AF and help them feel better. (Iranian Heart Journal 2021; 22(2): 68-76)
Keywords
Heart rate variability Biofeedback
Paroxysmal atrial fibrillation
Autonomic nervous system
  1. Kleiger RE, Bigger JT, Bosner RJ et al: Stability over time of variables measuring heart rate variability in normal subjects. Am J Cardiol 68: 626-630, 1991
  2. Bloomfield P :Fourier Analysis of Time-Series: An Introduction. New York, John Wiley, 1976
  3. Cohen L :Time-frequency distribution-A review. Proc IEEE, 77 :941-981,1989
  4. Malliani A, Pagani M, Lombardi F et al : Cardiovascular neural regulation explored in the frequency domain. Circulation 84:482-492, 1991
  5. Akselrod S, Gordon D, Ubel FA et al :Power spectrum analysis of heart rate fluctuation: A quantitative probe beat-to-beat cardiovascular control. Science 213: 210-222 1981
  6. Perini R, Orizio C, Baselli G et al: Time influence of exercise intensity on power spectrum of heart rate variability. Eur J Appl Physiol 61: 143-148 1990
  7. Bigger JT, Kleiger RE, Fleiss JL and The Multicenter Post-Infarction Research Group: Components of heart rate variability measured during healing of acute myocardial infarction. Am J Cardiol 61:208-215, 1988
  8. Ewing DJ, Campbell IW, Clarke BF: Mortality in diabetic autonomic neuropathy. Lancet 1:601-603, 1976
  9. Morady F and Zipes DP :Atrial Fibrillation: Clinical Features, Mechanisms and Management in Braunwald's Heart disease. Elsevier, 730-731, 2019
  10. RogerVL, Go AS, Lioyd-Jones DM et al Heart disease and stroke statistics-2012 update: A report from the American Heart Association. Circulation, 125-220, 2012
  11. Marie J. Cowan, Helen Kogan, N, Robert Burr MSEE, et al : Power Spectral Analysis of Heart Rate Variability after Biofeedback Training. J Electrocardiography vol. 23, 85-94, 1990
  12. Vaschillo E. Lehrer P,Rishe N et al : Heart rate variability biofeedback as a method for assessing baroreflex function: A preliminary study of resonance in the cardiovascular system. Appli Psychophysiol Biofeedback 27, 1-27, 2002
  13. Kleiger RE, Miller JP, Bigger JT et al: Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol 59:256, 1987
  14. Myers GA, Martin GJ, Magid NM et al: Power spectral analysis of heart rate variability in sudden cardiac death: comparison to other methods. IEEE Trans Biomed Eng 33: 1149, 1986
  15. David W Young : Self-measure of heart rate variability and arrhythmia to monitor and to manage atrial arrhythmias: personal experience with high intensity interval exercise (HIIE) for the conversion to sinus rhythm. Front. Physiol., 08 July 2014
  16. Boon KH, Hani Khalil, Malarvili MB: Paroxysmal atrial fibrillation based on heart rate variability analysis and non-dominated sorting genetic algorithm III Computer Methods and programs in Biomedicine. Vol 153, 171-184, 2018
  17. Wiegand UK, Bonnemeier H :Heart Rate Variability preceding atrial fibrillation. Hertz 26 (1), 49-54, 2001
  18. Vandenberg MP, Haaks maJ, Brouwer J : Heart Rate Variability in patients with Atrial Fibrillation is related to vagal tone. Circulation 1997, Aug 19: 96(4) 1209-16
  19. Vikman S, Makikallio TH,Yli-Mayrys et al : Heart rate variability and recurrence of atrial fibrillation after electrical cardioversion. Ann Med, 35(1) 36-42, 2003
  20. Ahsan A Khan,Gregory YH Lip, Alena Shantsila et al : Heart Rate Variability in Atrial Fibrillation: The balance between sympathetic and parasympathetic nervous system. :Europ J of Clinical Investigationvol, 49, issue 11, 2019
  21. Agarwal SK, Goldberger JJ , Mitrani RD et al: Low Heart Rate Variability linked to higher atrial fibrillation risk. J AM Coll Cardiol, 1016, 2017
  22. Friedman H S : Heart Rate Variability in Atrial Fibrillation, related to atrial size. Am J Cardiol, March 15, 93(6) 705-9,2004
  23. Lehrer P M and Gevirtz R: Heart rate variability biofeedback : How and why does it work?  Front Psychol vol 5 article 75, 21 July 2014
  24. Gevirtz R. The Promise of heart rate variability biofeedback: evidence-based applications.  Biofeedback 41,110-120 , 5298/1081-3937-41, 2013
  25. Bernston G, Bigger J, Eckberg D L et al : Heart rate variability: Origins, Methods and Interpretive caveats. Psychphysiology  , 34, 623-648,1997
  26. Lehler P and Eddie D: Dynamic processes in regulation and some implications for biofeedback and biobehavioral interventions. Appl Psychophysiol Biofeedback, 38(2), 143-155, 2013
  27. Paul Grossman, Edwin W. Taylor: Toward understanding respiratory sinus arrhythmia: Relations to cardiac vagal tone, evolution and biobehavioral functions Biological Psychology 74 , 263–285, 2007
  28. Lehrer P M, Vaschillo E, Vaschillo B et al : Heart rate variability biofeedback increases baroreflex gain and peak expiratory flow. Psychosom Med 2003, 65, 796-805
  29. Borovikova L V , Ivanova S, Zhang M et al :Vagus nerve stiulation attenuates the systemic inflammatory response to endotoxin. Nature, 2000, 404, 458-462
  30. Arun Kanmanthareddy, Madhu REDDY, Gopi Ponnaganti et al :Alternative medicine in atrial fibrillation, Yoga, Acupuncture, Biofeedback and more. J Thorac Dis 2015, Feb 7(2) 185-192
  31. Wan-Ling Chang, Jiunn Tay Lee, Chi Rongli et al : Effects of Heart rate variability Biofeedback in patients with acute ischemic stroke : A randomized controlled trial . Biological Research for Nursing, 2020, vol 22 Issue1
  32. Wan-Ling Chang, Jiunn-Tay Lee, Chi-Rong Li et all: Effects of Heart Rate Variability Biofeedback in Patients With Acute Ischemic Stroke: A Randomized Controlled Trial, Biological Research for Nursing, 2019
  33. Amanda L. Wheat • Kevin T. Larkin : Biofeedback of Heart Rate Variability and Related Physiology: A Critical Review. Appl Psychophysiol Biofeedback 35:229–242, 2010
  34. Nolan R, Kamath M, Floras J et al: Heart rate variability biofeedback as a behavioral neurocardiac intervention to enhance vagal heart rate control. American Heart Journal, 149, 1137–1137, 2005
  35. Hassett A, Radvanski D, Vascillio E : A Pilot Study of the Efficacy of Heart Rate Variability Biofeedback in Patients with Fibromyalgia.  Appl Psychophysiol Biofeedback 32:1–10, 2007
  36. Karavidas M, Lehrer P, Vaschillio E :Preliminary results of an open label study of heart rate variability biofeedback for the treatment of major depression. Appl Psychphysiol & Biofeedback 32, 19-30, 2007
Iranian Heart Journal
Volume 22, Issue 2
Spring 2021
Pages 68-76