Feasibility of pulse rate variability as feedback in closed-loop percutaneous auricular vagus nerve stimulation

Percutaneous auricular vagus nerve stimulation (pVNS) is a novel approach of treating cardiovascular and inflammatory diseases, as well as pain and neurological conditions. The treatment can be optimized by using biosignals as objective measures and feedback-control. One suitable biofeedback could be the use of pulse rate and pulse rate variability (PRV) derived from optical pulse plethysmography (PPG) instead of heart rate and heart rate variability (HRV) derived from electrocardiogram (ECG). For this purpose, a single-lead ECG on the thorax and a PPG on the earlobe were measured simultaneously on 10 healthy subjects for 420 s during three different respiratory phases. The data was analyzed and compared with scatterplots, the Pearson correlation coefficient and a Bland-Altman analysis. The outcomes show a very high correlation of heart rates from PPG and ECG (ri= 0.9663) and SDNN values (rsdnn= 0.9791). Comparison of RMSSD values showed a high positive correlation (rrmssd= 0.7963) but a mean overestimation of 10 ms in RMSSD values measured with the PPG. The results presented suggest that PRV could be and alternative biofeedback used in pVNS