• Ashim Maharjan, Mei Peng, Bruce Russell, and Yusuf Ozgur Cakmak.
• Cakmak Lab, Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand.
• Neuromodulation. 2022 Dec 1; 25 (8): 126812791268-1279.

ObjectivesThere is a wealth of literature supporting the use of median nerve stimulation (MNS) for modulating autonomic nervous system (ANS) dysfunction such as in hypoxia, recovery after heart valve replacement, ischemia, and cardiac contractibility. Heart rate variability (HRV) is considered a gold standard for measuring autonomic modulation and dynamic nonlinear ANS processes through the use of an electrocardiogram (ECG). Although the use of MNS on HRV in animals and humans has been documented, optimal stimulation parameters are yet to be outlined.Materials And MethodsThis review aims to synthesize findings of neurostimulation using MNS on animals and humans while observing HRV using an ECG. Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines with search parameters of "Median nerve stimulation," "Neiguan," "PC-6," "HRV," "Heart rate variability," and "Heart-rate variability" observing on animals and human subjects, we found a total of 17 eligible articles.ResultsIn this review, changing two parameters, that is, stimulation frequency and side of stimulation, appears to be the most influential in effecting frequency-domain ECG analysis of HRV. However, it is evident from this review that to perform an effective comparison of the effects of MNS on HRV, more detailed reports of the studies are required.ConclusionsFinding the optimal stimulation parameters for MNS is crucial for improving HRV. This will in turn contribute to normalizing ANS function impaired in numerous clinical conditions, such as epilepsy or diabetes.Copyright © 2021 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.

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