Effects of transcutaneous electrical acupoint stimulation on heart rate variability: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

ZHOU Mujiao ¹ , ZHANG Xiu ^1,2 , YANG Mengxuan ^1,2 , WANG Weijia ¹ ,  YANG Yonghong ^1,2

1. Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Key Laboratory of Rehabilitation Medicine of Sichuan Province, Chengdu 610041, P. R. China;

Corresponding author：

YANG Yonghong, Email: nicole308@126.com

Keywords：

Transcutaneous electrical acupoint stimulation; Heart rate variability; Systematic review; Meta-analysis; Autonomic nervous system

DOI：

10.7507/1672-2531.202304130

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review the effect of percutaneous acupoint electrical stimulation (TEAS) on heart rate variability (HRV). Methods The PubMed, Embase, Ovid MEDLINE, Cochrane Library, CNKI, WanFang Data, VIP, and CBM databases were electronically searched to collect randomized controlled trials (RCTs) on the effects of percutaneous acupoint electrical stimulation on heart rate variability from inception to February 28, 2023. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. Results A total of 14 RCTs involving 719 patients were included. The results of meta-analysis showed that SDNN (MD=12.95, 95%CI 9.18 to 16.72, P<0.01), RMSSD (MD=1.81, 95%CI 0.10 to 3.53, P=0.04), pNN50 (MD=1.75, 95%CI 1.02 to 2.48, P<0.01), HF (SMD=0.27, 95%CI 0.01 to 0.52, P=0.04), LF/HF (MD=−0.07, 95%CI −0.12 to −0.03, P<0.01), ln-LF (MD=0.63, 95%CI 0.25 to 1.01, P<0.01), ln-HF (MD=1.05, 95%CI 0.60 to 1.49, P<0.01), mean RR (MD=−11.86, 95%CI −21.77 to −1.96, P=0.02), and HR (SMD=−0.43, 95%CI −0.66 to −0.20, P<0.01) all showed improvement compared with the control group. However, there were no significant differences between the two groups in LF (SMD=0.15, 95%CI −0.10 to 0.40, P=0.23), LF norm (SMD=0.24, 95%CI −0.10 to 0.58, P=0.16) or HF norm (SMD=0.25, 95%CI −0.47 to 0.97, P=0.5). TEAS on PC6: SDNN, pNN50, HF, LF/HF, LF norm, HF norm, ln-LF, ln-HF, and HR all showed improvement compared with the control group. However, there were no significant differences between the two groups in RMSSD, LF, or RR interval. Conclusion This study supports the improvement of heart rate variability by transcutaneous acupoint electrical stimulation and PC6 acupoint selection. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.

Citation： ZHOU Mujiao, ZHANG Xiu, YANG Mengxuan, WANG Weijia, YANG Yonghong. Effects of transcutaneous electrical acupoint stimulation on heart rate variability: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2023, 23(12): 1393-1399. doi: 10.7507/1672-2531.202304130 Copy

1.	TASK FORCE. Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. European Heart Journal, 1996, 17(3): 354-381.
2.	Plaza-Florido A, Alcantara JMA, Migueles JH, et al. Inter- and intra-researcher reproducibility of heart rate variability parameters in three human cohorts. Sci Rep, 2020, 10(1): 11399.
3.	Xhyheri B, Manfrini O, Mazzolini M, et al. Heart rate variability today. Prog Cardiovasc Dis, 2012, 55(3): 321-331.
4.	Mejía-Mejía E, May JM, Elgendi M, et al. Differential effects of the blood pressure state on pulse rate variability and heart rate variability in critically ill patients. NPJ Digit Med, 2021, 4(1): 82.
5.	Souza HCD, Philbois SV, Veiga AC, et al. Heart rate variability and cardiovascular fitness: what we know so far. Vasc Health Risk Manag, 2021, 17: 701-711.
6.	张怡清, 温伟, 杨颖, 等. 针刺对心率变异性影响的Meta分析. 针灸临床杂志, 2021, 37(12): 39-46.
7.	Chen JM, Chiu PF, Chang YJ, et al. Effect of electroacupuncture on restless legs syndrome (RLS) in hemodialysis patients: a protocol for systematic review and meta-analysis. Medicine (Baltimore), 2020, 99(50): e23629.
8.	Chung JW, Yan VC, Zhang H. Effect of acupuncture on heart rate variability: a systematic review. Evid Based Complement Alternat Med, 2014, 2014: 819871.
9.	Wolf V, Kühnel A, Teckentrup V, et al. Does transcutaneous auricular vagus nerve stimulation affect vagally mediated heart rate variability. A living and interactive Bayesian meta-analysis. Psychophysiology, 2021, 58(11): e13933.
10.	高军龙, 李玉兰. 浅谈经皮穴位电刺激在围麻醉期的多种作用. 中国针灸, 2015, 35(3): 269-273.
11.	Zhou W, Deng Q, Jia L, et al. Acute effect of transcutaneous electroacupuncture on globus pharyngeus: a randomized, single-blind, crossover trial. Front Med (Lausanne), 2020, 7: 179.
12.	Chen LZ, Kan Y, Zhang ZY, et al. Neuropeptide initiated mast cell activation by transcutaneous electrical acupoint stimulation of acupoint LI4 in rats. Sci Rep, 2018, 8(1): 13921.
13.	Cumpston M, Li T, Page MJ, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev, 2019, (10): ED000142.
14.	Zeng X, Zhang Y, Kwong JS, et al. The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline: a systematic review. J Evid Based Med, 2015, 8(1): 2-10.
15.	Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ, 2019, 366: l4898.
16.	do Amaral Sartori S, Stein C, Coronel CC, et al. Effects of transcutaneous electrical nerve stimulation in autonomic nervous system of hypertensive patients: a randomized controlled trial. Curr Hypertens Rev, 2018, 14(1): 66-71.
17.	Chien LW, Lin MH, Chung HY, et al. Transcutaneous electrical stimulation of acupoints changes body composition and heart rate variability in postmenopausal women with obesity. Evid Based Complement Alternat Med, 2011, 2011: 862121.
18.	Ferreira AP, Ramos PDS, Dornelas BR, et al. Challenges in recruitment and adherence to a randomized clinical trial in Brazil on the effects of transcutaneous nervous electrical stimulation on individuals with peripheral arterial disease: a feasibility study. J Vasc Nurs, 2020, 38(4): 164-170.
19.	Jesus FG, Duque AP, Sant C, et al. Transcutaneous electrical nerve stimulation of pc5 and pc6 acupoints increases sympathovagal balance but not oxidative stress in healthy subjects: a randomized clinical trial. J Acupunct Meridian Stud, 2021, 14(5): 183-192.
20.	Li H, Wu C, Yan C, et al. Cardioprotective effect of transcutaneous electrical acupuncture point stimulation on perioperative elderly patients with coronary heart disease: a prospective, randomized, controlled clinical trial. Clin Interv Aging, 2019, 14: 1607-1614.
21.	Monaco A, Cattaneo R, Ortu E, et al. Sensory trigeminal ULF-TENS stimulation reduces HRV response to experimentally induced arithmetic stress: a randomized clinical trial. Physiol Behav, 2017, 173: 209-215.
22.	Wei W, Bai W, Yang Y, et al. Pulmonary protection of transcutaneous electrical acupoint stimulation in gynecological laparoscopic surgery: a randomized controlled trial. Exp Ther Med, 2020, 19(1): 511-518.
23.	Stampas A, Gustafson K, Korupolu R, et al. Bladder neuromodulation in acute spinal cord injury via transcutaneous tibial nerve stimulation: cystometrogram and autonomic nervous system evidence from a randomized control pilot trial. Front Neurosci, 2019, 13: 119.
24.	Yeh ML, Chung YC, Hsu LC, et al. Effect of transcutaneous acupoint electrical stimulation on post-hemorrhoidectomy-associated pain, anxiety, and heart rate variability: a randomized-controlled study. Clin Nurs Res, 2018, 27(4): 450-466.
25.	Yu DT, Jones AY. Are physiological changes experienced by healthy subjects during acu-TENS associated with acupuncture point sensations. Acupunct Med, 2014, 32(1): 28-36.
26.	蔡清香, 吴财能, 张志权, 等. 经皮穴位电刺激辅助麻醉对腰椎内固定术后患者心率变异性的影响. 广东医学, 2021, 42(8): 940-944.
27.	李惠洲, 吴川, 刘飞飞, 等. 经皮穴位电刺激对老年冠心病患者术后心率变异性和超敏肌钙蛋白T的影响. 临床麻醉学杂志, 2018, 34(7): 635-638.
28.	李进进, 赵文胜, 邵晓梅, 等. 经皮穴位电刺激对胃肠手术患者术后胃肠功能及自主神经功能的影响. 针刺研究, 2016, 41(3): 240-246.
29.	张立贤, 彭亮, 陈伟业, 等. 经皮穴位电刺激对严重烧伤患者的心肌细胞保护作用. 实用医学杂志, 2016, 32(9): 1428-1431.
30.	Routledge HC, Chowdhary S, Townend JN. Heart rate variability-a therapeutic target. J Clin Pharm Ther, 2002, 27(2): 85-92.
31.	Yan SP, Song X, Wei L, et al. Performance of heart rate adjusted heart rate variability for risk stratification of sudden cardiac death. BMC Cardiovasc Disord, 2023, 23(1): 144.
32.	Bilchick KC, Fetics B, Djoukeng R, et al. Prognostic value of heart rate variability in chronic congestive heart failure (Veterans Affairs' Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure). Am J Cardiol, 2002, 90(1): 24-28.
33.	Bhogal AS, De Rui M, Pavanello D, et al. Which heart rate variability index is an independent predictor of mortality in cirrhosis. Dig Liver Dis, 2019, 51(5): 695-702.
34.	Tan R, He Y, Zhang S, et al. Effect of transcutaneous electrical acupoint stimulation on protecting against radiotherapy- induced ovarian damage in mice. J Ovarian Res, 2019, 12(1): 65.
35.	庄秀秀, 羊丽丽, 王露, 等. 不同强度经皮穴位电刺激对使用止血带后下肢手术患者肺功能及氧自由基的影响. 针刺研究, 2019, 44(8): 594-598.
36.	Zhang B, Xu F, Hu P, et al. Needleless transcutaneous electrical acustimulation: a pilot study evaluating improvement in post-operative recovery. Am J Gastroenterol, 2018, 113(7): 1026-1035.
37.	Zhang B, Zhu K, Hu P, et al. Needleless transcutaneous neuromodulation accelerates postoperative recovery mediated via autonomic and immuno-cytokine mechanisms in patients with cholecystolithiasis. Neuromodulation, 2019, 22(5): 546-554.
38.	Zhu Y, Li X, Ma J, et al. Transcutaneous electrical acustimulation improves gastrointestinal disturbances induced by transcatheter arterial chemoembolization in patients with liver cancers. Neuromodulation, 2020, 23(8): 1180-1188.
39.	Lee S, Lee MS, Choi JY, et al. Acupuncture and heart rate variability: a systematic review. Auton Neurosci, 2010, 155(1-2): 5-13.

1. TASK FORCE. Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. European Heart Journal, 1996, 17(3): 354-381.
2. Plaza-Florido A, Alcantara JMA, Migueles JH, et al. Inter- and intra-researcher reproducibility of heart rate variability parameters in three human cohorts. Sci Rep, 2020, 10(1): 11399.
3. Xhyheri B, Manfrini O, Mazzolini M, et al. Heart rate variability today. Prog Cardiovasc Dis, 2012, 55(3): 321-331.
4. Mejía-Mejía E, May JM, Elgendi M, et al. Differential effects of the blood pressure state on pulse rate variability and heart rate variability in critically ill patients. NPJ Digit Med, 2021, 4(1): 82.
5. Souza HCD, Philbois SV, Veiga AC, et al. Heart rate variability and cardiovascular fitness: what we know so far. Vasc Health Risk Manag, 2021, 17: 701-711.
6. 张怡清, 温伟, 杨颖, 等. 针刺对心率变异性影响的Meta分析. 针灸临床杂志, 2021, 37(12): 39-46.
7. Chen JM, Chiu PF, Chang YJ, et al. Effect of electroacupuncture on restless legs syndrome (RLS) in hemodialysis patients: a protocol for systematic review and meta-analysis. Medicine (Baltimore), 2020, 99(50): e23629.
8. Chung JW, Yan VC, Zhang H. Effect of acupuncture on heart rate variability: a systematic review. Evid Based Complement Alternat Med, 2014, 2014: 819871.
9. Wolf V, Kühnel A, Teckentrup V, et al. Does transcutaneous auricular vagus nerve stimulation affect vagally mediated heart rate variability. A living and interactive Bayesian meta-analysis. Psychophysiology, 2021, 58(11): e13933.
10. 高军龙, 李玉兰. 浅谈经皮穴位电刺激在围麻醉期的多种作用. 中国针灸, 2015, 35(3): 269-273.
11. Zhou W, Deng Q, Jia L, et al. Acute effect of transcutaneous electroacupuncture on globus pharyngeus: a randomized, single-blind, crossover trial. Front Med (Lausanne), 2020, 7: 179.
12. Chen LZ, Kan Y, Zhang ZY, et al. Neuropeptide initiated mast cell activation by transcutaneous electrical acupoint stimulation of acupoint LI4 in rats. Sci Rep, 2018, 8(1): 13921.
13. Cumpston M, Li T, Page MJ, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev, 2019, (10): ED000142.
14. Zeng X, Zhang Y, Kwong JS, et al. The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline: a systematic review. J Evid Based Med, 2015, 8(1): 2-10.
15. Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ, 2019, 366: l4898.
16. do Amaral Sartori S, Stein C, Coronel CC, et al. Effects of transcutaneous electrical nerve stimulation in autonomic nervous system of hypertensive patients: a randomized controlled trial. Curr Hypertens Rev, 2018, 14(1): 66-71.
17. Chien LW, Lin MH, Chung HY, et al. Transcutaneous electrical stimulation of acupoints changes body composition and heart rate variability in postmenopausal women with obesity. Evid Based Complement Alternat Med, 2011, 2011: 862121.
18. Ferreira AP, Ramos PDS, Dornelas BR, et al. Challenges in recruitment and adherence to a randomized clinical trial in Brazil on the effects of transcutaneous nervous electrical stimulation on individuals with peripheral arterial disease: a feasibility study. J Vasc Nurs, 2020, 38(4): 164-170.
19. Jesus FG, Duque AP, Sant C, et al. Transcutaneous electrical nerve stimulation of pc5 and pc6 acupoints increases sympathovagal balance but not oxidative stress in healthy subjects: a randomized clinical trial. J Acupunct Meridian Stud, 2021, 14(5): 183-192.
20. Li H, Wu C, Yan C, et al. Cardioprotective effect of transcutaneous electrical acupuncture point stimulation on perioperative elderly patients with coronary heart disease: a prospective, randomized, controlled clinical trial. Clin Interv Aging, 2019, 14: 1607-1614.
21. Monaco A, Cattaneo R, Ortu E, et al. Sensory trigeminal ULF-TENS stimulation reduces HRV response to experimentally induced arithmetic stress: a randomized clinical trial. Physiol Behav, 2017, 173: 209-215.
22. Wei W, Bai W, Yang Y, et al. Pulmonary protection of transcutaneous electrical acupoint stimulation in gynecological laparoscopic surgery: a randomized controlled trial. Exp Ther Med, 2020, 19(1): 511-518.
23. Stampas A, Gustafson K, Korupolu R, et al. Bladder neuromodulation in acute spinal cord injury via transcutaneous tibial nerve stimulation: cystometrogram and autonomic nervous system evidence from a randomized control pilot trial. Front Neurosci, 2019, 13: 119.
24. Yeh ML, Chung YC, Hsu LC, et al. Effect of transcutaneous acupoint electrical stimulation on post-hemorrhoidectomy-associated pain, anxiety, and heart rate variability: a randomized-controlled study. Clin Nurs Res, 2018, 27(4): 450-466.
25. Yu DT, Jones AY. Are physiological changes experienced by healthy subjects during acu-TENS associated with acupuncture point sensations. Acupunct Med, 2014, 32(1): 28-36.
26. 蔡清香, 吴财能, 张志权, 等. 经皮穴位电刺激辅助麻醉对腰椎内固定术后患者心率变异性的影响. 广东医学, 2021, 42(8): 940-944.
27. 李惠洲, 吴川, 刘飞飞, 等. 经皮穴位电刺激对老年冠心病患者术后心率变异性和超敏肌钙蛋白T的影响. 临床麻醉学杂志, 2018, 34(7): 635-638.
28. 李进进, 赵文胜, 邵晓梅, 等. 经皮穴位电刺激对胃肠手术患者术后胃肠功能及自主神经功能的影响. 针刺研究, 2016, 41(3): 240-246.
29. 张立贤, 彭亮, 陈伟业, 等. 经皮穴位电刺激对严重烧伤患者的心肌细胞保护作用. 实用医学杂志, 2016, 32(9): 1428-1431.
30. Routledge HC, Chowdhary S, Townend JN. Heart rate variability-a therapeutic target. J Clin Pharm Ther, 2002, 27(2): 85-92.
31. Yan SP, Song X, Wei L, et al. Performance of heart rate adjusted heart rate variability for risk stratification of sudden cardiac death. BMC Cardiovasc Disord, 2023, 23(1): 144.
32. Bilchick KC, Fetics B, Djoukeng R, et al. Prognostic value of heart rate variability in chronic congestive heart failure (Veterans Affairs' Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure). Am J Cardiol, 2002, 90(1): 24-28.
33. Bhogal AS, De Rui M, Pavanello D, et al. Which heart rate variability index is an independent predictor of mortality in cirrhosis. Dig Liver Dis, 2019, 51(5): 695-702.
34. Tan R, He Y, Zhang S, et al. Effect of transcutaneous electrical acupoint stimulation on protecting against radiotherapy- induced ovarian damage in mice. J Ovarian Res, 2019, 12(1): 65.
35. 庄秀秀, 羊丽丽, 王露, 等. 不同强度经皮穴位电刺激对使用止血带后下肢手术患者肺功能及氧自由基的影响. 针刺研究, 2019, 44(8): 594-598.
36. Zhang B, Xu F, Hu P, et al. Needleless transcutaneous electrical acustimulation: a pilot study evaluating improvement in post-operative recovery. Am J Gastroenterol, 2018, 113(7): 1026-1035.
37. Zhang B, Zhu K, Hu P, et al. Needleless transcutaneous neuromodulation accelerates postoperative recovery mediated via autonomic and immuno-cytokine mechanisms in patients with cholecystolithiasis. Neuromodulation, 2019, 22(5): 546-554.
38. Zhu Y, Li X, Ma J, et al. Transcutaneous electrical acustimulation improves gastrointestinal disturbances induced by transcatheter arterial chemoembolization in patients with liver cancers. Neuromodulation, 2020, 23(8): 1180-1188.
39. Lee S, Lee MS, Choi JY, et al. Acupuncture and heart rate variability: a systematic review. Auton Neurosci, 2010, 155(1-2): 5-13.

Chinese Journal of Evidence-Based Medicine

Effects of transcutaneous electrical acupoint stimulation on heart rate variability: a meta-analysis

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