Detection of abnormal and induction of normal heat rate variability

• US 6,487,442 B1
• Filed: 04/28/2000
• Issued: 11/26/2002
• Est. Priority Date: 04/28/2000
• Status: Expired due to Fees

• Current Assignee: GW Scientific Incorporated
• Original Assignee: GW Scientific Incorporated
• Inventors: Wood, Nicholas
• Primary Examiner(s): Getzow, Scott M.
• Application Number:
  US09/559,653
• Time in Patent Office: 942 Days
• Field of Search: 600/513, 600/515, 600/516, 600/517, 600/518, 600/519
• US Class Current: 600/515
• CPC Class Codes: A61B 5/0022 Monitoring a patient using a global network, e.g. telephone networks, internet
• CPC Class Codes: A61B 5/364 Detecting abnormal ECG interval, e.g. extrasystoles, ectopic heartbeats
• CPC Class Codes: A61B 5/4035 Evaluating the autonomic nervous system

Abstract

An apparatus and method for predicting potentially fatal arrhythmias up to twenty four hours in advance of the event by employing formulas indicating either too little or too much heart rate variability. A number of these formulas have both predetermined upper and lower limits, which if exceeded for a period of time are a predictor of a potentially fatal arrhythmia. When a patient'"'"'s ALARM condition is predicted, whether the patient is indoors or outdoors, conscious or unconscious, a redundant protocol is utilized to relay that ALARM condition to a central monitoring station. The central monitoring station informs the patient'"'"'s doctor, and then uses what ever means are available to transport the patient to the nearest emergency room for treatment. An apparatus and method for pacing the heart in a natural way, once a potentially fatal arrhythmia has been predicted is also disclosed.

Claims

1. A method of predicting arrhythmia in a person comprising the steps of:

measuring the heart rate of the person,

analyzing the measured heart rate to determine a value for at least one marker for Heart Rate Variability; and

comparing the determined value with both a standard predetermined upper limit and a standard predetermined lower limit for the at least one marker, the upper limit indicates decreased variability, and the lower limit indicates increased variability, the at least one marker including at least one parameter of sympathetic or parasympathetic activity.

2. The method of claim 1, wherein the at least one marker comprises at least one parameter selected from the group consisting of Abs.SPS, Abs.AMo, Abs.DX, Abs.DX/M, and Abs.FWHM, Abs.SDANN, Abs.AM, Abs.ANN, and determining the at least one marker occurs over a Time Segment comprising about 25 to about 501 Time Intervals.

3. The method of claim 2, wherein the at least one marker comprises Abs.SPS (Absolute Sympathetic Parasympathetic Stress),

wherein, for ambulatory patients age 18 to 54,

the upper limit is about 48, and further comprising signaling a Caution if the value for Abs.SPS is determined as greater than or equal to the upper limit for a ratio of at least about 5 out of 50 Time Segments, and signaling an ALARM if the value for Abs.SPS is determined as greater than or equal to the upper limit for a ratio of at least about 30 out of 50 Time Segments, wherein at least about 30 Time Segments are measured, and

the lower limit is about 2.5 and further comprising signaling a Caution if the value for Abs.SPS is determined as less than or equal to the lower limit for a ratio of at least about 15 out of 50 Time Segments, and signaling an ALARM if the value for Abs.SPS is determined as less than or equal to the lower limit for a ratio of at least about 25 out of 50 Time Segments, wherein at least about 30 Time Segments are measured.

4. The method of claim 2, wherein the at least one marker comprises Abs.AMo (Absolute Amplitude of the Mode),

wherein, for ambulatory patients age 18 to 54,

the upper limit is about 90 and further comprising signaling a Caution if the value for Abs.AMo is determined as greater than or equal to the upper limit for a ratio of at least about 15 out of 50 Time Segments, and signaling an ALARM if the value for Abs.AMo is determined as greater than or equal to the upper limit for a ratio of at least about 30 out of 50 Time Segments, wherein at least about 30 Time Segments are measured;

and

the lower limit is 10, and further comprising signaling a Caution if the value for Abs.AMo is determined as less than or equal to the lower limit for a ratio of at least about 15 out of 50 Time Segments, and signaling an ALARM if the value for Abs.AMo is determined as less than or equal to the lower limit for a ratio of at least about 25 out of 50 Time Segments, wherein at least about 30 Time Segments are measured.

5. The method of claim 2, wherein the at least one marker comprises Abs.DX (Absolute Delta X)

wherein, for ambulatory patients age 18 to 54,

the upper limit is about 0.50 and further comprising signaling a Caution if the value for Abs.DX is determined as greater than or equal to the upper limit for a ratio of at least about 15 out of 50 Time Segments, and signaling an ALARM if the value for Abs.DX is determined as greater than or equal to the upper limit for a ratio of at least about 30 out of 50 Time Segments, wherein at least about 30 Time Segments are measured;

and

the lower limit is about 0.06 and further comprising signaling a Caution if the value for Abs.DX is determined as less than or equal to the lower limit for a ratio of at least about 10 out of 50 Time Segments, and signaling an ALARM if the value for Abs.DX is determined as less than or equal to the lower limit for a ratio of at least about 25 out of 50 time Segments, wherein at least about 30 Time Segments are measured.

6. The method of claim 2, wherein the at least one marker comprises Abs.DX/M (Absolute Delta X divided by the Median),

wherein, for ambulatory patients age 18 to 54,

the upper limit is about 0.425 and further comprising signaling a Caution if the value for Abs.DX/M is determined as greater than or equal to the upper limit for a ratio of at least about 15 out of 50 Time Segments, and signaling an ALARM if the value for Abs.DX/M is determined as greater than or equal to the upper limit for a ratio of at least about 25 out of 50 Time Segments, wherein at least about 30 Time Segments are measured;

and

the lower limit Caution is about 0.02, further comprising signaling a Caution if the value for Abs.DX/M is determined as less than or equal to the lower limit for a ratio of at least about 5 out of 50 Time Segments, and signaling an ALARM if the value for Abs.DX/M is determined as less than or equal to the lower limit for a ratio of at least about 25 out of 50 Time Segments, wherein at least about 30 Time Segments are measured.

7. The method of claim 2, wherein the at least one marker comprises Abs.SPS (Absolute Sympathetic Parasympathetic Stress),

wherein, for ambulatory patients age 18 to 54,

the upper limit is about 45 to about 50, and further comprising signaling a Caution if the value for Abs.SPS is determined as greater than or equal to the upper limit for a ratio of at least about 4 to about 6 out of 50 Time Segments, and signaling an ALARM if the value for Abs.SPS is determined as greater than or equal to the upper limit for a ratio of at least about 28 to about 32 out of 50 Time Segments, wherein at least about 30 Time Segments are measured and

the lower limit is about 2.5 and further comprising signaling a Caution if the value for Abs.SPS is determined as less than or equal to the lower limit for a ratio of at least about 13 to 17 out of 50 Time Segments, and signaling an ALARM if the value for Abs.SPS is determined as less than or equal to the lower limit for a ratio of at least about 23-27 out of 50 Time Segments, wherein at least about 30 Time Segments are measured.

8. The method of claim 1, wherein the at least one marker comprises at least one parameter selected from the group consisting of PNN50, ACRR and MARR.

9. The method of claim 1, wherein HRV Status points are assigned as relative values as follows:

a) Caution equals −

0.5 points or +0.5 points

b) ALARM equals −

1 point or +1 point

c) Low HRV Caution and ALARM equals two and one half points

d) ACRR Caution and ALARM equals two and one half points

e) Low or High Heart Rate ALARM equals two and one half points

f) MARR ALARM equals two and one half points;

a combined total of all points generated, which equals between −

1.99 and +1.99 points or less is an OK status;

a combined total of all points generated, which equals from about −

2.0 to −

2.49 or equals from about +2.0 to +2.49 points is a Caution status;

a combined total of all points generated, which equals about −

2.5 points or less or equals about +2.5 points or more is a ALARM status.

10. The method of claim 1, wherein the at least one parameter is low-HRV, and further comprising signaling a low-HRV status Alarm if in a Time Segment a maximum Time Interval variation of about 0.62 seconds or lower is determined, with no more than two Time Segments having a Time Interval variation of above about 0.62 seconds, per about 100 or more Time Segments.

11. The method of claim 1, wherein the at least one parameter comprises ACRR Time Intervals, ACRR Time Intervals being Time Intervals between consecutive heart beats which are 25% less or 25% more than the previous Time Interval, and

further comprising signaling an HRV Status Alarm if more than 50 minutes of ACRR Time Intervals are measured with no more than two consecutive Time Intervals which did not qualify as an ACRR Time Interval.

12. The method of claim 11, wherein an ACRR interval has a duration of 1>

74 or 126>

169 milliseconds.

13. The method of claim 1, further comprising signaling an HRV Status ALARM if the at least one parameter comprises MARR Time Intervals, MARR Time Intervals being a condition when a current pulse wave peak is preceded by about 5 to about 15 hundredths of a second by a preceding pulse wave peak, and the current peak is 25% to 90% less or 25% to 200% more than said preceding peak, and at least five minutes of said MARR Time Intervals are measured and there are no more than three consecutive Time Intervals which did not qualify as a MARR Time Segment during the time the at least five minutes was measured.

14. The method of claim 13, wherein an MARR interval has a duration of 0 or ≧

170 milliseconds.

15. The method of claim 1, wherein the at least one marker comprises Abs.SPS (Absolute Sympathetic Parasympathetic Stress),

wherein, for ambulatory patients of age 55+,

the upper limit is about 48, and further comprising signaling a Caution if the value for Abs.SPS is determined as greater than or equal to the upper limit for a ratio of at least about 10 out of 50 Time Segments, and signaling an ALARM if the value for Abs.SPS is determined as greater than or equal to the upper limit for a ratio of at least about 15 out of 50 Time Segments and at least about 30 Time Segments are measured, and

the lower limit is about 4 and further comprising signaling a Caution if the value for Abs.SPS is determined as less than or equal to the lower limit for a ratio of at least about 10 out of 50 Time Segments, and signaling an ALARM if the value for Abs.SPS is determined as less than or equal to the lower limit for a ratio of at least about 15 out of 50 Time Segments, wherein at least about 30 Time Segments are measured.

16. The method of claim 1, wherein the at least one marker comprises Abs.AMo (Absolute Amplitude of the Mode),

wherein, for ambulatory patients age 55+,

the upper limit is about 90 and further comprising signaling a Caution if the value for Abs.AMo is determined as greater than or equal to the upper limit for a ratio of at least about 10 out of 50 Time Segments, and signaling an ALARM if the value for Abs.AMo is determined as greater than or equal to the upper limit for a ratio of at least about 15 out of 50 Time Segments, wherein at least about 30 Time Segments are measured;

and

the lower limit is about 10, and further comprising signaling a Caution if the value for Abs.AMo is determined as less than or equal to the lower limit for a ratio of at least about 15 out of 50 Time Segments, and signaling an ALARM if the value for Abs.AMo is determined as less than or equal to the lower limit for a ratio of at least about 20 out of 50 Time Segments, wherein at least about 30 Time Segments are measured.

17. The method of claim 1, wherein the at least one marker comprises Abs.DX (Absolute Delta X)

wherein, for ambulatory patients age 55+,

the upper limit is about 0.50 and further comprising signaling a Caution if the value for Abs.DX is determined as greater than or equal to the upper limit for a ratio of at least about 10 out of 50 Time Segments, and signaling an ALARM if the value for Abs.DX is determined as greater than or equal to the upper limit for a ratio of at least about 15 out of 50 Time Segments, wherein at least about 30 Time Segments are measured;

and

the lower limit is about 0.06 and further comprising signaling a Caution if the value for Abs.DX is determined as less than or equal to the lower limit for a ratio of at least about 15 out of 50 Time Segments, and signaling an ALARM if the value for Abs.DX is determined as less than or equal to the lower limit for a ratio of at least about 20 out of 50 time Segments, wherein at least about 30 Time Segments are measured.

18. The method of claim 1, wherein the at least one marker comprises Abs.DX/M (Absolute Delta X divided by the Median),

wherein, for ambulatory patients age 55+,

the upper limit is about 0.425 and further comprising signaling a Caution if the value for Abs.DX/M is determined as greater than or equal to the upper limit for a ratio of at least about 15 out of 50 consecutive Time Segments, and signaling an ALARM if the value for Abs.DX/M is determined as greater than or equal to the upper limit for a ratio of at least about 20 out of 50 Time Segments, wherein at least about 30 Time Segments are measured;

and

the lower limit Caution is about 0.02, further comprising signaling a Caution if the value for Abs.DX/M is determined as less than or equal to the lower limit for a ratio of at least about 5 out of 50 Time Segments, and signaling an ALARM if the value for Abs.DX/M is determined as less than or equal to the lower limit for a ratio of at least about 15 out of 50 Time Segments, wherein at least about 30 Time Segments are measured.

19. The method of claim 1, further comprising the step of providing the patient with a wrist monitor, and a communication system comprising at least one member of the group consisting of a phone for communicating with a land line, a cellular telephone, and a pager,

wherein the at least one marker comprises at least one member of the group consisting of Abs.SPS, Abs.AMo, Abs.DX, Abs.DX/M, and Abs.FWHM, Abs.SDANN, Abs.AM, Abs.ANN, Heart Rate, Low HRV, and ACRR, and

comprising said measuring of the heart rate of the person by measuring pulse with the wrist monitor during at least one Time Segment and calculating Points with the wrist monitor for the at least one marker based on the measurement of the heart rate during the at least one Time Segment, and then summing and storing the points with the wrist monitor thereby creating an HRV Status report, the wrist monitor comprising a microprocessor programed for said calculating and summing, and having memory for said storing.

20. The method of claim 19, wherein if a sufficient number of points are calculated and summed the HRV Status report detects an HRV ALARM condition,

if the HRV ALARM condition is detected in the HRV Status report, then the patient'"'"'s communication system will first try to communicate with the land line to make a connection with a central monitoring station, and

failing to make a connection with the central monitoring station the patient'"'"'s communication system will then try to communicate with the central monitoring station using at least one member of the group consisting of the cellular telephone and the pager,

if the communication system is unable to connect to the central monitoring station after about at least 10 minutes, the wrist monitor will trigger at least one alarm selected from the group consisting of:

(1) a flashing red light, (2) vibration, and (3) a pre-recorded voice message suggesting that an HRV Status ALARM condition has been detected, and to please go to the nearest Emergency Room.

21. The method of claim 1, wherein the at least one marker comprises at least two parameters selected from the group consisting of Abs.SPS, Abs.AMo, Abs.DX, Abs.DX/M, and Abs.FWHM, Abs.SDANN, Abs.AM, Abs.ANN, Heart Rate, Low HRV, and ACRR determined over a Time Segment comprised of about 25 to about 501 Time Intervals.

22. The method of claim 1, wherein the at least one marker comprises at least three parameters selected from the group consisting of Abs.SPS, Abs.AMo, Abs.DX, Abs.DX/M, and Abs.FWHM, Abs.SDANN, Abs.AM, Abs.ANN, Heart Rate, Low HRV, and ACRR determined over a Time Segment comprised of about 25 to 501 Time Intervals.

23. The method of claim 1, wherein the at least one marker comprises Abs.AMo (Absolute Amplitude of the Mode),

wherein, for ambulatory patients age 18 to 54,

the upper limit is about 85 to 95 and further comprising signaling a Caution if the value for Abs.AMo is determined as greater than or equal to the upper limit for a ratio of at least about 13 to 17 out of 50 Time Segments, and signaling an ALARM if the value for Abs.AMo is determined as greater than or equal to the upper limit for a ratio of at least about 28 to 32 out of 50 Time Segments, wherein at least about 30 Time Segments are measured;

and

the lower limit is 8 to 12, and further comprising signaling a Caution if the value for Abs.AMo is determined as less than or equal to the lower limit for a ratio of at least about 13 to 17 out of 50 Time Segments, and signaling an ALARM if the value for Abs.AMo is determined as less than or equal to the lower limit for a ratio of at least about 23 to 27 out of 50 Time Segments, wherein at least about 30 Time Segments are measured.

24. The method of claim 1, wherein the at least one marker comprises Abs.DX (Absolute Delta X)

wherein, for ambulatory patients age 18 to 54,

the upper limit is about 0.4 to about 0.6 and further comprising signaling a Caution if the value for Abs.DX is determined as greater than or equal to the upper limit for a ratio of at least about 13 to about 17 out of 50 Time Segments, and signaling an ALARM if the value for Abs.DX is determined as greater than or equal to the upper limit for a ratio of at least about 28 to about 32 out of 50 Time Segments, wherein at least about 30 Time Segments are measured;

and

the lower limit is about 0.05 to about 0.07 and further comprising signaling a Caution if the value for Abs.DX is determined as less than or equal to the lower limit for a ratio of at least about 8 to about 12 out of 50 Time Segments, and signaling an ALARM if the value for Abs.DX is determined as less than or equal to the lower limit for a ratio of at least about 23 to about 27 out of 50 Time Segments, wherein at least about 30 Time Segments are measured.

25. The method of claim 1, wherein the at least one marker comprises Abs.DX/M (Absolute Delta X divided by the Median),

wherein, for ambulatory patients age 18 to 54,

the upper limit is about 0.4 to 0.5 and further comprising signaling a Caution if the value for Abs.DX/M is determined as greater than or equal to the upper limit for a ratio of at least about 13 to about 17 out of 50 Time Segments, and signaling an ALARM if the value for Abs.DX/M is determined as greater than or equal to the upper limit for a ratio of at least about 23 to 27 out of 50 Time Segments, wherein at least about 30 Time Segments are measured;

and

the lower limit Caution is about 0.015 to 0.025, further comprising signaling a Caution if the value for Abs.DX/M is determined as less than or equal to the lower limit for a ratio of at least about 4 to 6 out of 50 Time Segments, and signaling an ALARM if the value for Abs.DX/M is determined as less than or equal to the lower limit for a ratio of at least about 23 to 27 out of 50 Time Segments, wherein at least about 30 Time Segments are measured.

26. The method of claim 1, wherein RR time intervals are measured and normal intervals (NN) are 75>

125 milliseconds, ACRR intervals are 1>

74 and 126>

169 milliseconds, and MARR intervals are 0 and 170+ milliseconds.

27. The method of claim 1, wherein the at least one marker comprises kurtosis (a₄)

wherein, for ambulatory patients age 18 to 54,

further comprising signaling an Increased HRV DX ALARM if the value of kurtosis (a₄) is ≧

30 for a ratio of at least about 28 to 31 out of 50 Time Segments, wherein at least about 30 Time Segments are measured; and

signaling an Decreased HRV DX ALARM if the value for kurtosis (a₄) is ≦

0.3 for at least about 23 to 26 out of 50 Time Segments, wherein at least about 30 Time Segments are measured.

28. The method of claim 1, wherein the at least one marker comprises Abs.SPS (Absolute Sympathetic Parasympathetic Stress),

wherein, for ambulatory patients of age 55+,

the upper limit is about 48±

4.8, and further comprising signaling a Caution if the value for Abs.SPS is determined as greater than or equal to the upper limit for a ratio of at least about 10±

2 out of 50 Time Segments, and signaling an ALARM if the value for Abs.SPS is determined as greater than or equal to the upper limit for a ratio of at least about 15±

2 out of 50 Time Segments and at least about 30 Time Segments are measured, and

the lower limit is about 4±

0.4 and further comprising signaling a Caution if the value for Abs.SPS is determined as less than or equal to the lower limit for a ratio of at least about 10±

2 out of 50 Time Segments, and signaling an ALARM if the value for Abs.SPS is determined as less than or equal to the lower limit for a ratio of at least about 15±

2 out of 50 Time Segments, wherein at least about 30 Time Segments are measured.

29. The method of claim 1, wherein the at least one marker comprises Abs.AMo (Absolute Amplitude of the Mode),

wherein, for ambulatory patients age 55+,

the upper limit is about 90±

9 and further comprising signaling a Caution if the value for Abs.AMo is determined as greater than or equal to the upper limit for a ratio of at least about 10±

2 out of 50 Time Segments, and signaling an ALARM if the value for Abs.AMo is determined as greater than or equal to the upper limit for a ratio of at least about 15±

2 out of 50 Time Segments, wherein at least about 30 Time Segments are measured; and

the lower limits about 10±

1, and further comprising signaling a Caution if the value for Abs.AMo is determined as less than or equal to the lower limit for a ratio of at least about 15±

2 out of 50 Time Segments, and signaling an ALARM if the value for Abs.AMo is determined as less than or equal to the lower limit for a ratio of at least about 20±

2 out of 50 Time Segments, wherein at least about 30 Time Segments are measured.

30. The method of claim 1, wherein the at least one marker comprises Abs.DX (Absolute Delta X)

wherein, for ambulatory patients age 55+,

the upper limit is about 0.50±

0.05 and further comprising signaling a Caution if the value for Abs.DX is determined as greater than or equal to the upper limit for a ratio of at least about 10±

2 out of 50 Time Segments, and signaling an ALARM if the value for Abs.DX is determined as greater than or equal to the upper limit for a ratio of at least about 15±

2 out of 50 Time Segments, wherein at least about 30 Time Segments are measured; and

the lower limit is about 0.06±

0.006 and further comprising signaling a Caution if the value for Abs.DX is determined as less than or equal to the lower limit for a ratio of at least about 15±

2 out of 50 Time Segments, and signaling an ALARM if the value for Abs.DX is determined as less than or equal to the lower limit for a ratio of at least about 20±

2 out of 50 time Segments, wherein at least about 30 Time Segments are measured.

31. The method of claim 1, wherein the at least one marker comprises Abs.DX/M (Absolute Delta X divided by the Median),

wherein, for ambulatory patients age 55+,

the upper limit is about 0.425±

0.0425 and further comprising signaling a Caution if the value for Abs.DX/M is determined as greater than or equal to the upper limit for a ratio of at least about 15±

2 out of 50 consecutive Time Segments, and signaling an ALARM if the value for Abs.DX/M is determined as greater than or equal to the upper limit for a ratio of at least about 20±

2 out of 50 Time Segments, wherein at least about 30 Time Segments are measured; and

the lower limit Caution is about 0.02±

0.002, further comprising signaling a Caution if the value for Abs.DX/M is determined as less than or equal to the lower limit for a ratio of at least about 5±

1 out of 50 Time Segments, and signaling an ALARM if the value for Abs.DX/M is determined as less than or equal to the lower limit for a ratio of at least about 15±

2 out of 50 Time Segments, wherein at least about 30 Time Segments are measured.

32. An apparatus comprising,

a wrist monitor, said wrist monitor comprising a microprocessor, memory, a motion detector and an RF transmitter, and

a communication system comprising at least one member of the group consisting of a phone for communicating with a land line, a cellular telephone, and a pager,

said wrist monitor comprising a microprocessor programmed to perform the method of claim 1.

37. An apparatus comprising,

a wrist monitor, said wrist monitor comprising a microprocessor, memory, and a Time Interval sensor, and

said microprocessor programmed to perform the method of claim 1.

33. An apparatus for predicting arrhythmia in a person, comprising,

a wrist monitor for:

measuring the heart rate of the person,

analyzing the measured heart rate to determine a value for at least one marker for Heart Rate Variability; and

comparing the determined value with both a standard predetermined upper limit and a standard predetermined lower limit for the at least one marker, the upper limit indicates decreased variability, and the lower limit indicates increased variability, the at least one marker including at least one parameter of sympathetic or parasympathetic activity, said wrist monitor comprising a microprocessor, memory, a motion detector and an RF transmitter, and

a communication system comprising at least one member of the group consisting of a phone for communicating with a land line, a cellular telephone, and a pager,

wherein the at least one marker comprises at least one member selected from the group consisting of Abs.SPS, Abs.AMo, Abs.DX, Abs.DX/M, and Abs.FWHM, Abs.SDANN, Abs.AM, Abs.ANN,Heart Rate, Low HRV, and ACRR, determined over a Time Segment comprising about 25 to about 501 Time Intervals and Points are calculated for the Time Segment, then summed and stored creating an HRV Status report by the wrist monitor, the wrist monitor comprising a microprocessor programed to make said calculations and summing, and memory for said storing.

34. The apparatus of claim 33, wherein said RF transmitter is capable of communicating with at least one member of the group consisting of a cellular telephone and a pager.

35. An apparatus for predicting arrhythmia in a person, comprising,

a wrist monitor for:

measuring the heart rate of the person,

analyzing the measured heart rate to determine a value for at least one marker for Heart Rate Variability; and

comparing the determined value with both a standard predetermined upper limit and a standard predetermined lower limit for the at least one marker, the upper limit indicates decreased variability, and the lower limit indicates increased variability, the at least one marker including at least one parameter of sympathetic or parasympathetic activity, and

a communication system comprising a phone for communicating with a land line, a cellular telephone, and a pager,

wherein the at least one marker comprises at least one member selected from the group consisting of Abs.SPS, Abs.AMo, Abs.DX, Abs.DX/M, and Abs.FWHM, Abs.SDANN, Abs.AM, Abs.ANN,Heart Rate, Low HRV, and ACRR, determined over a Time Segment comprising about 25 to about 501 Time Intervals and Points and are calculated for the Time Segment, then summed and stored creating an HRV Status report by the wrist monitor, the wrist monitor comprising a microprocessor programed to make said calculations and summing, and memory for said storing.

36. The apparatus of claim 35, wherein if an HRV ALARM condition is detected in the HRV Status report, then the patient'"'"'s communication system will first try its land line to make a connection with the central monitoring station, and failing to make a connection with the central monitoring station will then try to communicate with the central monitoring station using at least one member of the group consisting of the cellular telephone and the pager, if the communication system is unable to connect to the central monitoring station after about at least 10 minutes, the wrist monitor will trigger at least one alarm selected from the group consisting of (1) a flashing red light, (2) vibration, and (3) a pre-recorded voice message suggesting that an HRV Status ALARM condition has been detected, and to please go to the nearest Emergency Room.

38. A method for regulating heart rate comprising having a pacemaker implanted in a human induce variation into the human'"'"'s heart rate, such that, when the breathing rate is in the range of 24 to 27 breaths per minute or more, the pacing rate would range from about 0.5 to about 0.42 seconds over a predetermined time segment.

39. A pacemaker for implanting in a human programmed to induce variation into the human'"'"'s heart rate, such that, when the breathing rate is in the range of 24 to 27 breaths per minute or more, the pacing rate would range from about 0.5 to about 0.42 seconds over a predetermined time segment.

40. The pacemaker of claim 39, wherein the pacemaker is an impedance pacemaker and is programmed to provide the heart rate variability based on a record of the patient'"'"'s heart rate variability based on a record of the patient'"'"'s heart rate variability.

41. The pacemaker of claim 39, wherein the pacemaker is an impedance pacemaker and is programmed to provide the heart rate variability based on a record of the patient'"'"'s heart rate variability based on a record of heart rate variability of an individual most nearly matching the patient'"'"'s age, sex, race, build and athletic condition.

42. The pacemaker of claim 39, wherein the pacemaker is an impedance pacemaker and is programmed to provide the heart rate variability based on a record of the patient'"'"'s heart rate variability based on a random pulse rate generator.