Assessment Services

Heart rate variability analysis has proven an invaluable tool in gaining deeper insight into the nature of the autonomic imbalances and dysrhythmias now known to be associated with wide variety of pathologies. In addition, analysis of HRV is a useful, noninvasive method for assessing the effects of different treatments and interventions on the autonomic nervous system. The Autonomic Assessment Report, described next, is a detailed analysis that IHM has developed to measure autonomic nervous system function and balance. HeartMath Research Center employs this analysis to measure and monitor autonomic improvements in many patients who have chosen to incorporate the HeartMath emotional management interventions into their recovery programs. This service is also utilized by physicians and scientists in a variety of clinical and research settings.

The Autonomic Assessment Report: A Comprehensive Heart Rate Variability Analysis & Interpretation Guide & Instructions
Rollin McCraty, PhD and Alan D. Watkins, MBBS. Boulder Creek, CA: Institute of HeartMath; 1996.

Key points: The Autonomic Assessment Report is a powerful, noninvasive diagnostic tool that provides a comprehensive, quantitative analysis of autonomic nervous system function and balance. This analysis is of value in the diagnosis and treatment of disorders that involve autonomic dysrhythmias and in assessing the effects of therapeutic interventions on autonomic function. The HeartMath Research Center provides this analysis service to physicians and medical institutions throughout the U.S. and abroad. Summary: The Autonomic Assessment Report (AAR) is a sophisticated tool for quantifying autonomic function developed by the HeartMath Research Center. The aims of the AAR are: (1) to provide physicians with a new, powerful, noninvasive test which quantifies autonomic function and balance and aids in risk stratification; (2) to offer researchers a test that can measure the effects of their interventions on autonomic function, and (3) to generate data that will allow the autonomic profiles in a number of pathological conditions to be more fully characterized. The AAR is derived from 24hour ambulatory ECG (Holter) recordings, and is based on analysis of heart rate variability (HRV), which provides a unique window into the interactions of sympathetic and parasympathetic control of the heart. The report includes time domain, frequency domain and circadian rhythm analysis, which together constitute a comprehensive analysis of autonomic activity, balance and rhythms. Time domain measures include the mean normal-to-normal (NN) intervals during a 24-hour recording and statistical measures of the variance between NN intervals. Power spectral density analysis is used to assess how power is distributed as a function of frequency, providing a means to quantify autonomic balance at any given point in the 24-hour period, as well as to chart the circadian rhythms of activity in the two branches of the autonomic nervous system. Disease States Associated with Autonomic Dysrhythmias: Depression Irritable Bowel Hypoglycemia Fibromyalgia Panic Disorder

Hypertension Sleep Disorder Chemical Sensitivity Premenstrual Syndrome Asthma Fatigue Anxiety Dizziness Migraine Nausea Arrhythmia Mitral Valve Prolapse

The Autonomic Assessment Report Interpretation Guide Autonomic imbalances have been implicated in a wide variety of pathologies, including depression, fatigue, premenstrual syndrome, hypertension, diabetes mellitus, ischemic heart disease, coronary heart disease and environmental sensitivity. The AAR affords physicians a powerful diagnostic tool to detect abnormalities and imbalances in the autonomic nervous system and predict those at increased risk of developing various pathologies often before symptoms become manifest. Stress and emotional states have been shown to dramatically affect autonomic function. Self-management techniques, which enable individuals to gain greater control of their mental and emotional stress and improve their sympathovagal balance, can significantly impact a wide variety of disorders in which autonomic imbalance plays a role. The AAR analysis has permitted the quantitative demonstration of the effects of the HeartMath interventions in rebalancing the autonomic nervous system in many patients who have been able to significantly improve their symptomatology and psychological well-being through practice of the techniques. The Autonomic Assessment Report Interpretation Guide and Instructions booklet, available from IHM, provides clinicians with understandable descriptions of HRV measures used in the report and how to interpret them in clinical applications. It includes instructions in Holter recorder use and a number of case histories and clinical examples.

The Autonomic Assessment Report

Figure 55.

Sample pages from the Autonomic Assessment Report. Shown from left to right are: (1) 24-Hour Heart Rate Profile (top) and Heart Rate Variability Index plot (bottom), (2) 24-Hour Autonomic Balance Profile and (3) Circadian Rhythm Analysis page. Not shown are the data summary sheet and the 24-hour heart rate tachogram pages.