Sierra Wave Help Manual

RR Interval
RR Interval Basic Steps

Select the RR Interval Test:

• If a Study has already been selected, simply click on the RR Interval
test protocol within the Study window or turn Knob #1 (Study Item / Site)
to highlight the test.
• If a Study has not been selected, or you don't want to use a Study.
Select the RR Interval test protocol from the Study/Test menu.

Follow these steps for performing the RR Interval test:

1. Apply electrodes to the patient and connect to amplifier
Surface electrodes are used to record the ECG signal. Connect the
electrodes to Act1-Ref1 inputs so that the ECG peak is shown as an upward
deflection in the trace window. The Live ECG signal is displayed as soon as
the test protocol is loaded.
2. Verify Amplifier Settings
Check the Gain, Hicut, Locut, and Sweep Speed settings and make sure
they are appropriate. You want to visualize 3 or more ECG peaks across
the sweep.
Typical Settings

Gain Hicut Locut Sweep

(uV/Div) (Hz) (Hz) Speed
(ms/Div)

RR Interval 200-500 50 1 200

3. Adjust the Peak Detection Threshold

The peak detection threshold line should be positioned about halfway up the
ECG peak. Use Knob #3 (Trigger Level) to move the detection line up or
down. The RR Interval (ms) or Heart Rate (bmp) will be shown in blue text
next to the ECG peak.

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RR Interval Trace window.

4. Select a Run in the RR Interval Table

The RR Interval test protocol supports up to 5 preprogrammed data
acquisition runs. This table labels the run and controls the amount of time
(duration) that the Sierra Wave will acquire data. Click on a row in the table
to select it and give instructions to the patient that are appropriate for the run
selected (e.g., begin deep breathing).

RR Interval Run Table.

5. Begin Data Acquisition

Press the Run/Stop key on the Sierra Wave base unit to begin data
acquisition. The text Recording Run #n will be displayed in the trace
window to indicate that the Sierra Wave is acquiring RR Interval data for the
selected run. RR Datapoints will begin to be plotted within the RR
Datapoint Graph.
6. Enter Events (optional)
Events can be entered during data collection by pressing the F1 (Events)
function key.

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Type in the text for the event or select a preprogrammed event from the
drop-down list and then click the OK button. A dashed vertical line will
appear in the RR Datapoint Graph to indicate the event.
7. Stop Data Acquisition
The program will automatically stop data acquisition when the Duration
setting specified for the run has been reached. You can also manually stop
data acquisition at any time by pressing the Run/Stop key. As soon as data
acquisition is stopped the program will calculate and display the results for
the run in the RR Interval Table.

The Live ECG trace will continue to be displayed even though data
collection has stopped.

Completed RR Interval Table and corresponding Datapoint Graph for Run #4.

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The program displays the following measurements for each run:

• Min RR - minimum RR interval recorded during the run.
• Max RR - maximum RR interval recorded during the run.
• Mean RR - the mean RR interval for the run.
• Min/Max Ratio - the ratio of the minimum to maximum RR interval for
the run.
• SD - the standard deviation of the RR interval for the run.
• Variance % - the percentage of variance for the run. (Max – Min) /
Mean x 100

The program can be configured to display the results in Heart Rate

(bpm) values rather than RR Intervals (ms). Please refer to the RR
Interval Setup topic for details.
8. Make Adjustments to RR Datapoint Graph (optional)
The following functions can be performed within the RR Datapoint Graph.
• Change Y-Axis - click on the upper or lower limit of the Y-axis and
then enter the desired value. The graph will automatically be re-
drawn.
• Calculate Ratio - the program automatically calculates the Min/Max
Ratio for the lowest and highest values recorded within the run. You
can also manually calculate a ratio between any two selected data
points. The manually calculated ratio is displayed in the upper right
corner of the datapoint graph and in the User Ratio column of the RR
Interval table.
To calculate a manual ratio:
a. Right click within the datapoint graph.
b. Select Calculate Ratio from the pop-up menu.
c. Click on the first data point, the data point will be
displayed in green.
d. Click on the second data point, the data point will be
displayed in green.
e. The ratio is calculated and displayed in the upper right
corner.
• Clear Ratio - select this option in the pop-up menu to clear a manual
ratio.

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• Enter Event - right click on the data point corresponding to where you
would like to enter an event, then select Enter Event from the pop-up
menu. Type in the text for the event, or select a preprogrammed
event from the list, then click OK. A dashed vertical line will be
displayed in the graph.

Position the mouse over the vertical dashed line to view

a pop-up box of the event text.
• Clear Event - to remove an event, right click over the vertical dashed
line and select Clear Event from the pop-up menu.
• Reject Data Point - to remove a data point, right click over the point
and select Reject Data Point from the pop-up menu. The deleted
point will be shown in gray color.

RR Datapoint Graph and right-click menu.

9. Repeat Steps 4-9 for other Runs

To record additional runs, repeat steps 4 through 9.
10. TabData (optional)
To view a Summary window of all the tests done on the patient, press the F4
(TabData) function key on the Sierra Wave base unit.
The left hand side of the TabData window shows all the tests that were
performed on the patient. It also has entries for Summary Tables (i.e., Motor
Summary table, Anti Sensory table, Muscle Scoring table).
To view the results for an individual test:
Highlight the test by turning Knob #1 (Select / Open) on the Sierra Wave
base unit or by clicking on the test with the mouse. The selected test's
traces and cursor information will be displayed on the right hand side of the
window.

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To view a Summary Table:

Highlight the table by turning Knob #1 (Select / Open) on the Sierra Wave
base unit or by clicking on the Summary Table with the mouse. The
selected table will be displayed on the right hand side of the window.
To print a Report:
Click on one of the report buttons at the bottom of the TabData window, or
press the corresponding function key on the Sierra Wave base unit.
11. Next Test (optional)
To change Test Protocols:
• Use Knob #1 (Study Item / Site) to highlight another Test Protocol in
the Study window.
• Click on another Test Protocol in the Study window using the
mouse.
• Press the Select key on the Sierra Wave base unit and select a
Test Protocol from the Study/Test menu.

Knob & Fkey Controls (RR Interval)

Knobs

Study Item - turn this knob to highlight and load a different Test
Protocol in the Study window.
Trigger Lvl - turn this knob to change the vertical position of the ECG
trigger level indicator.
Gain / Sweep - turn the knob to change the gain of the ECG trace.
Press the knob, then turn to change the sweep speed of the ECG trace.

Function Keys

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Event - opens the Add Event window which allows you enter an event
during a recording.
TabData - opens the TabData Summary window.

RR Datapoint Graph

The following functions can be performed within the RR Datapoint Graph.

RR Datapoint Graph and right-click menu.

• Change Y-Axis - simply click on the upper or lower limit of the Y-axis
and then enter the desired value. The graph will automatically be re-
drawn.
• Calculate Ratio - the program automatically calculates the Min/Max
Ratio for the lowest and highest values recorded within the run. You
can also manually calculate a ratio between any two selected data
points. The manually calculated ratio is displayed in the upper right
corner of the datapoint graph and in the User Ratio column of the run
table.
To calculate a manual ratio:
a. Right click within the datapoint graph.
b. Select Calculate Ratio from the pop-up menu.
c. Click on the first data point, the data point will be
displayed in green.
d. Click on the second data point, the data point will be
displayed in green.
e. The ratio is calculated and displayed in the upper right
corner.

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• Clear Ratio - select this option in the pop-up menu to clear a manual
ratio.
• Enter Event - right click on the data point corresponding to where you
would like to enter an event, then select Enter Event from the pop-up
menu. Type in the text for the event, or select a preprogrammed
event from the list, then click OK. A dashed vertical line will be
displayed in the graph.

Position the mouse over the vertical dashed line to view

a pop-up box of the event text.
• Clear Event - to remove an event, right click over the vertical dashed
line and select Clear Event from the pop-up menu.
• Reject Data Point - to remove a data point, right click over the point
and select Reject Data Point from the pop-up menu. The deleted
point will be shown in gray color.
• Ascii Output - allows the RR interval data points to be output to an
ASCII file. The ASCII file is saved as a ‘comma separated values’
file; this means it can be opened easily with a spreadsheet or analysis
program.

Reviewing a Run

To review the Datapoint Graph for a Run, perform one of the following:
• Click on Run # in Study window.
• Click on the Run's corresponding row in the RR Interval Table
In both cases, the Datapoint Graph for the selected run will be displayed.

If no data was acquired for the selected run, the Datapoint Graph will be
empty.

Deleting/Clearing a Run

To Delete or Clear the data for a Run, perform one of the following:
• Right click on the Run # in the Study window, select Delete from the
pop-up menu.
• Right click over the Run's corresponding row in the RR Interval Table,
select Clear Row from the pop-up menu.

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In both cases, the tabulated results for the run will be erased and the
Datapoint Graph will be cleared.

Normative Data

Deep Breathing:
6 breaths per minute for 1 or 2 minutes (5 seconds inhale, 5 seconds
exhale).

AGE (yrs) Norm Max/Min Ratio

16-20 >1.23

21-25 >1.20

26-30 >1.18

31-35 >1.16

36-40 >1.14

41-45 >1.12

46-50 >1.11

51-55 >1.09

56-60 >1.08

61-65 >1.07

66-70 >1.06

71-75 >1.06

75-80 >1.05

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Example Deep Breathing (42 year old)

Valsalva Maneuver:
Patient inhales deeply and then forcibly exhales into a leaky mouthpiece and
maintains a constant pressure for 15-20 seconds before releasing and
completely exhaling.
Ratio is calculated using the Max RR after cessation of forced exhale divided
by the Min RR during the 15-20 seconds of forced exhale.

AGE (yrs) Norm Max/Min Ratio

10-40 >1.5

41-50 >1.45

51-60 >1.45

61-70 >1.35

Example Valsalva Maneuver (42 year old)

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Sitting To Standing:
Patient goes from sitting position to standing up. The 30:15 ratio is typically
calculated, this is the RR interval at beat 30 after standing divided by the RR
Interval at beat 15 after standing.

AGE (yrs) Norm 30:15 Ratio

10-29 >1.17

30-49 >1.09

50-65 >1.03

Example Sitting-To-Standing (42 year old)

Reference:
AAEM Minimonograph #48
Autonomic Nervous System Testing
John M. Ravits, MD
Muscle & Nerve, August 1997

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