Welcome to the Afibber’s Forum
Serving Afibbers worldwide since 1999
Moderated by Shannon and Carey


Afibbers Home Afibbers Forum General Health Forum
Afib Resources Afib Database Vitamin Shop


Welcome! Log In Create A New Profile

Advanced

Beat fluctuation

Posted by Lynn 
Beat fluctuation
September 24, 2015 09:57AM
After downloading the new Alivecor app update, I noticed that they added beat fluctuation. I am assuming this is the same as heartrate variability. The higher the number, the better. Mine has been running around 80, but I have no idea what an optimal score would be or what strategies to use to increase my numbers.

It is interesting to note that prior to the start of my afib episodes my chiro was quite concerned after administering a heartrate variability test. I blew it off because I was spinning regularly at the time and felt very fit and energetic.
Re: Beat fluctuation
September 24, 2015 12:44PM
My beat fluctuation (bfx) is usually very low 0 to 20 on average. I also would like to know more about it.
Re: Beat fluctuation
September 24, 2015 01:36PM
Here is a bit on HRV <[www.marksdailyapple.com] HRV decreases with stress and also age. High HRV is considered an indicator of high parasympathetic tone. Usually a good thing, but may not be so good for a vagal afibber. On the AliveCor, my readings tend to be in the 40-60 range.

George
Re: Beat fluctuation
September 24, 2015 02:35PM
I have been in afib for a day and a half...longest ever. Anyway, a couple non afib days were around 40, all day yesterday around 80, then high heart rates this morning in afib the rates were down to 40, after beta blockers and half a Valium its up to 80 again. Had big stress yesterday and have modified my b vitamin regimin.

Interesting article tho. Makes me think this could be a good tool to objectively measure different treatments we try such as yoga, sleep apnea treatment, acupuncture, etc.
Re: Beat fluctuation
September 24, 2015 08:00PM
Hi Lynn,

Quote

After downloading the new Alivecor app update, I noticed that they added beat fluctuation. I am assuming this is the same as heartrate variability. The higher the number, the better. Mine has been running around 80, but I have no idea what an optimal score would be or what strategies to use to increase my numbers.

I thought the same thing... at first. I now think that Alivecor needs some serious tuning on their HRV (heart rate variability) algorithm.

I've now been in afib twice (since having the Alivecor update), and my Alivecor HRV score has been much higher when I'm in afib than when I'm in NSR (normal sinus rhythm). In afib, it's consistently 70 - 100. In NSR, it's 25 - 60.

Having said that, I actually *do* think there's merit to the HRV concept. I've got a 2007 era device (with the cheezy name of "Stress Eraser" ) that does (IMO) an infinitely better job of calculating (and displaying) HRV. And it has actually been much more accurate than Alivecore w/r/t predicting when I'm on the cusp of going into afib. In happy NSR, I get really nice sine waves with the StressEraser. And when I'm on the cusp of afib, the Stress Eraser often displays PVC's (spikes) interrupting the sine waves and/or the sine waves themselves are much more erratic (jaggy, not smooth transitions). And once I'm in afib, the waveform displayed by the Stress Eraser (which graphs R-to-R timing) looks like Brownian motion (randomly changes direction), rather than being a nice sine wave.

The Stress Eraser is not perfect though. It often fails to sync when I'm in afib, and it doesn't work well with cold fingers. So this can have a negative feedback effect (ie, increase mental stress, which increases the probability of going into afib). Sometimes when I think I'm on the cusp of afib, the Stress Eraser won't sync (won't provide readout), which made me think I was about to go into afib. Now that I hae the Alivecor, when the StressEraser fails to sync I just switch to the Alivecor (which works with cold fingers) and it typically just shows me a few PVC's. Later when my fingers warmed up, the Stress Eraser confirmed the findings.

Cheers,
-Ted
Re: Beat fluctuation
September 25, 2015 11:19AM
Ted,

I am assuming we have greater HRV when we are in afib because the rhythm is irregular and more variable. When using your other device what is your HRV number before going into afib and how does it compare to your HRV when you are relaxed an in NSR. I am out of afib now and my HRV is 48. I am curious as to whether afibbers in NSR have lower HRV scores. If so, could raising those scores decrease afib episodes.

I wonder what HRV is in a person without afib. I guess I will test other members of my family.
Re: Beat fluctuation
September 25, 2015 01:39PM
Lynn – This report may be of interest:

Heart Rate Variability Test: New Way of Evaluating Physical Fitness and Predicting Sudden Death Syndrome
by Larisa Tereshchenko, MD, PhD and Simon Yu, MD

Every so often we witness some of the most physically fit people die from a sudden, unexpected heart attack. What happened to those people who seem so physically fit and can run 20 miles or lift 300 lbs of weight? Why do they suddenly drop dead without any warning signs that there might be something wrong with them? Are there any other tests besides a cardiac stress test to predict their true physical fitness and high risk for sudden death?

Presently, not well known to most physicians, the Heart Rate Variability (HRV)test is an established, non-invasive electrophysiology test for an assessment of the cardiac autonomic nervous system. It evaluates one’s general physical fitness. The test predicts increased probability of sudden unexplained death by simply measuring minor variation in one’s heart rate. In Russia, cosmonauts and submarine crews have been routinely tested with the HRV test to screen for individuals who can handle the required job stress.

Heart rate is not fixed. In healthy individuals , heart rate varies constantly as a means to adapt to internal and external stress. Heart rate automatically adjusts for stress from emotional conflict, heavy metal toxicity, hidden dental distress, allergies, respiration, metabolic changes, thermoregulation, physical exertions and long-term diurnal
and endocrine cycles.

The modulation of heart rate is primarily the result of alterations of the autonomic nervous system as represented by the parasympathetic system (for your ability to relax, repair, digest, eliminate and sleep) and the sympathetic system (for fight or flight). If you can’t relax from stress or worry and your system is dominated by fear and tension, your autonomic nervous system is dominated by a suppressed parasympathetic system and overly stimulated sympathetic system. In this situation, you have an increase in overall risk for sudden death despite your physical ability to run 20 miles or lift 300 lbs of weight. In lay person’s terms, your nervous system is “stressed out” to maximum or “maxed out.”

Minor heart rate variation can be measured by computer and categorized for sympathetic and parasympathetic dominance. A low HRV score, which usually means high sympathetic score and negative parasympathetic score, is often associated with increased risk of all-cause mortality. Modern men and women are living in highly stressful conditions and often have low HRV scores. Low HRV has also been proposed as a marker for many chronic disease conditions. (Task Force of the European Society of Cardiology and the North American Society of Pacing Electrophysiology, 1996)
Continue: [www.preventionandhealing.com]


The Referenced Study published in Circulation:

Heart Rate Variability

Standards of Measurement, Physiological Interpretation, and Clinical Use

Task Force of the European Society of Cardiology the North American Society of Pacing Electrophysiology
Correspondence to Marek Malik, PhD, MD, Chairman, Writing Committee of the Task Force, Department of Cardiological Sciences, St George’s Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK.

The last two decades have witnessed the recognition of a significant relationship between the autonomic nervous system and cardiovascular mortality, including sudden cardiac death.1 2 3 4 Experimental evidence for an association between propensity for lethal arrhythmias and signs of either increased sympathetic or reduced vagal activity has spurred efforts for the development of quantitative markers of autonomic activity.

HRV represents one of the most promising such markers. The apparently easy derivation of this measure has popularized its use. As many commercial devices now provide an automated measurement of HRV, the cardiologist has been provided with a seemingly simple tool for both research and clinical studies.5 However, the significance and meaning of the many different measures of HRV are more complex than generally appreciated, and there is a potential for incorrect conclusions and for excessive or unfounded extrapolations.

Recognition of these problems led the European Society of Cardiology and the North American Society of Pacing and Electrophysiology to constitute a Task Force charged with the responsibility of developing appropriate standards. The specific goals of this Task Force were to (1) standardize nomenclature and develop definitions of terms, (2) specify standard methods of measurement, (3) define physiological and pathophysiological correlates, (4) describe currently appropriate clinical applications, and (5) identify areas for future research.

To achieve these goals, the members of the Task Force were drawn from the fields of mathematics, engineering, physiology, and clinical medicine. The standards and proposals offered in this text should not limit further development but should allow appropriate comparisons, promote circumspect interpretations, and lead to further progress in the field.

The phenomenon that is the focus of this report is the oscillation in the interval between consecutive heartbeats as well as the oscillations between consecutive instantaneous heart rates. “Heart rate variability” has become the conventionally accepted term to describe variations of both instantaneous heart rate and RR intervals. To describe oscillation in consecutive cardiac cycles, other terms have been used in the literature, for example, cycle length variability, heart period variability, RR variability, and RR interval tachogram, and they more appropriately emphasize the fact that it is the interval between consecutive beats that is being analyzed rather than the heart rate per se. However, these terms have not gained as wide acceptance as HRV; thus, we will use the term HRV in this document.
Continue: [circ.ahajournals.org]



My experience with HRV testing began in 2012 with an initial score of 83. With treatment, six months later, it was 89 and a year later, it was 98. This was part of a series of physical assessments to determine the state of core neurological and spinal functions which quantify neural efficiency.

95- 100 considered Excellent
90 – 94 Very Good
80-89 Good
70-79 – Transition
60-69 Challenged
0 – 59 Very challenged

The Interpretation Guide on the Pulse Wave Profiler indicates this is a method to determine your overall ability to adapt to the environment. It does this by looking at the timing of your pulse and determining the balance and tension within our nervous system. This exam is known as heart rate variability.

Stressful lifestyle habits including poor dietary choices, limited exercise and constant emotional aggravation can cause the body to be caught in the “fight-fight” response. This can lead to exhaustion and draining of a person’s reserves.

A score within the green box on the graph is associated with better adaptability and relates to a healthy lifestyle. Low heart rate variability is associated with accelerated aging and poor heart health. Published research has shown that spinal alignment chiropractic adjustments have a beneficial effect on heart rate variability.

Jackie
Re: Beat fluctuation
September 26, 2015 02:17AM
Hi Jackie,

I'm guessing the HRV numbers & ranges you show are specific to the Pulse Wave Profiler. Who knows how AliveCor calculates theirs? There are many different ways to analyze R to R variability so it would be unusual if the AliveCor readings and Pulse Wave use the same algorithm.

Ecotopics will also increase your HRV as will afib (in the extreme). Obviously that is not what we're after. Likewise how you time your breathing will change respiratory sinus arrhythmia (RSA). In general, inhales will increase your rate and exhales slow it. For many people a 5 second inhale and 5 second exhale will maximize RSA & therefore HRV.

It is an interesting concept, but there are things that can skew it as well as a number of different time series mathematical concepts that can be used to measure it.

Probably the best technique is to consistently test on the same machine, when you are in NSR and have minimal ectopics. Then compare apples to apples.

George



Edited 1 time(s). Last edit at 09/26/2015 02:42AM by GeorgeN.
Re: Beat fluctuation
September 26, 2015 05:51AM
Hi Lynn,

Quote

I am assuming we have greater HRV when we are in afib because the rhythm is irregular and more variable. When using your other device what is your HRV number before going into afib and how does it compare to your HRV when you are relaxed an in NSR. I am out of afib now and my HRV is 48. I am curious as to whether afibbers in NSR have lower HRV scores. If so, could raising those scores decrease afib episodes.

You are correct, Alivecor's HRV number is high when one is afib. That's the problem I was trying to point out, and why I find it useless: their HRV algorithm doesn't let one distinguish between good "high HRV" and bad "high HRV". So it's not useful for judging whether one's lifestyle/supplement/meditation/etc tweaks are taking them towards healthy or unhealthy heart rhythms.

My other device (StressEraser) avoids this problem completely... by not trying to condense the HRV into a single number. Instead it draws a real-time graph, based on the R-R variability (which after all defines HRV). When someone has a healthy HRV, this R-R distance will slowly increase, peak, then slowly decrease. Corresponding to one's breathing.

A picture is worth 1,000 words, so please have a look at the first diagram in Science behind EmWave paper. This shows how the R-R distance of an EKG varies when breathing.

Now take a look at a second picture, Figure 1 in the StressEraser HRV biofeedback paper, from the 2008 Association of Applied Psychophysiology & Biofeedback. Figure 1 shows (graphically) how the R-R values vary, when one is in a healthy HRV: it looks exactly like a sine wave.

When I'm in happy NSR, I get a nice sine wave. But when I'm on the cusp of afib, the (normal, healthy) respiratory sinus arrhythmia pattern does not look like a sine wave at all - it's very jaggy, and seems random. (Unfortunately I can't post a photo of it, because the StressEraser doesn't keep a copy of old waveforms). When I'm in NSR, but have a few PVC's, the PVC's clearly show up as sharp spikes in the sine wave.

One could perhaps (roughly) derive this same R-R information by staring at the AliveCore EKG graph in real-time and mentally keeping track of the R-R variation distance. Orby looking at a saved 30 second AliveCor recording and analyzing the R-R variations with calipers. The eyeball calculation method is frustrating, and the caliper method is tedious. In contrast, with the StressEraser, I can tell instantly how healthy my HRV variations are: is it a nice smooth sine wave (healthy NSR, high HRV)? A sine wave that's jaggy (lower HRV score)? A waveform that's nowhere close to a sine wave (afib)? A since wave with random sharp spikes (PVC's)?

Furthermore the form factor and design of the StressEraser make it very easy to just put the StressEraser on one finger just hold it casually, and occasionally glance at it while meditating (or relaxing, or watching TV), to see how much I'm improving (or failing to improve) my HRV coherence. It's a great bio feedback mechanism.

Disclaimer: I have no financial connection to StressEraser. And their product is off the market (apparently it failed to catch on).

Cheers,
-Ted



Edited 1 time(s). Last edit at 09/26/2015 06:02AM by apache.
Re: Beat fluctuation
December 06, 2015 05:32PM
Apache,

Are these biofeedback systems a way to follow your heart as an AF and understand more what is going on? Do they help an afibber?
I am asking because I have the Journey To Wild Divine biofeedback software, with the IOM biofeedback device and I'm interested to see if it would be of any help to my aunt, Nicole, with AF. We're trying to find out more about her AF. (Jackie is helping me on another thread to find proper ways to help her cope and improve).
I've tried myself years ago this biofeedback and I am aware of part of the HeartMath Institute studies and I do believe in what they do and that it works, at least for a non-afibber, to reach heart coherence.

Thank you,

Andrea
Re: Beat fluctuation
December 07, 2015 09:00PM
Hi Andrea,

Quote

Are these biofeedback systems a way to follow your heart as an AF and understand more what is going on? Do they help an afibber?

Yes, and maybe (it depends on the particular afibber).

The StressEraser is useful for me to manage (avoid) afib. However I lie somewhat outside the Bell curve of the general population as I have a significant math and analytical background (electrical engineering undergrad degree from MIT, and a comp sci master's degree from Stanford). I've also done quite a bit of research into HRV and thus perhaps have greater insight into what the R-R variability StressEraser waveform is telling me than a casual user might.

Judging by the lack of feedback in this thread (other than yours, that is!), it appears that the StressEraser is not that useful for the those with a more conventional background.

It doesn't take a technical background to use the tool, but it sure helps one appreciate (and use) the information being conveyed. It's too bad the StressEraser didn't catch on in the marketplace, because IMHO there is no other HRV biofeedback tool which is nearly as well-designed.

Even from a non-technical perspective, I find the StressEraser to be quite useful as it gives me instant feedback on my meditation practice, so I can see what is "working" and what is not, and modify accordingly.

Cheers,
-Ted
Re: Beat fluctuation
December 07, 2015 10:26PM
Andrea S,

With regard to the biofeedback systems as well as magnesium and other supplemental protocols .. These are all very much worthwhile in trying and adopting as an adjunctive therapy for your aunt that 'might' help some to a modest degree, but in her case as reported so far with permanent ( or long standing persistent AFIcool smiley and at her age, the odds are very slim that these efforts will replace the need for first an electro-cardioversion which is often attempted a few times first and/or an expert ablation process that you aunt in all likelihood really needs most to make real progress toward long term freedom from arrhythmia.

She will likely do best adopting good dietary and supplemental support as Jackie and others have noted, but don't spend too much time with those more natural
Means ALONE and solely as her only focus now, and with the expectation that she should spend a year seeing if they work for her before even considering an expert ablation process now..

She will almost certainly need all the help she can get, including the ablation process with a EU EP and likely not one in Romania based on the feedback I got from a handful of top Ablationists from three different US centers this weekend I posed the question to about who they might recommend for a persistent to long standing persistent AF ablationist in Romania. The composite and unanimous answer from all three EPs was to encourage you to seek out a top center in one of the other EU countries if that was at all feasible for you and your aunt financially?

Keep in mind you want to target an ablationist who is highly experienced and has a successful track record with long standing persistent AFIB cases. Alas, in Europe there are not a large number of EPs who specialize in LSPAF. And the few locations I noted in our last correspondance are a couple options that have a higher degree of reliability based on my admittedly limited knowledge of eastern EU EPs. That is why I inquired from several very experienced ablationists who are all frequent speakers at major AF conferences for what I would expect is a wider view of the regional options in eastern Europe as a whole.

You can certainly interview with Dr. V. that researcher noted but please verify his experience level with long standing persistent cases and try to get some idea of what procedural steps he uses in his ablations for such cases and let me know. Hopefully, even if he turns out not to be the best choice you can arrange for her for an ablation, he might well work out fine as a long term Clinical EP to follow and manage your aunt, and hopefully after she has had a successful ablation process elsewhere. Assuming your own research confirms and inspires you too to look beyond the border to countries better known for their AFIB ablation research.

Best wishes with what ever decisions you make and your aunt is very fortunate to have a relative as dedicated as you are in helping her sort out a challenging situation for sure!!

Be well,
Shannon
Re: Beat fluctuation
December 15, 2015 05:59AM
Apache,
thank you for answering. I do agree with you, that one needs to have a background to understand more about certain devices/software and use them fully.

Shannon,
thank you very much for asking around and your answer to me. I couldn't have found out these things on my own!
As this is a serious thing I will take into consideration helping her have in Romania what is safe and the advanced procedures to be done abroad (but only after we solve the money issue and if she wants it...). For now I am here with her and tomorrow we are going to the hospital to see if she is ready for electro-cardioversion. She is scared about what is next. I am trying not to talk much about the subject for now. I don't want to stress her... We're taking one step at a time...

Be well,
Andrea
Sorry, only registered users may post in this forum.

Click here to login