Targeting method

Heart-brain coupling

Heart-brain coupling in Marylebone, London is how we decide where to place the coil, by measuring the way your heart responds to test pulses at several candidate sites before any course begins.

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Coil positioning at the Naya clinic, UNTIL Marylebone

The short answer

What heart-brain coupling is

Most clinics place the coil using a fixed measurement from the scalp. It is quick, and it assumes every head is arranged the same way. Heart-brain coupling replaces that assumption with a measurement taken from you.

Candidate sites over the dorsolateral prefrontal cortex are tested one at a time. We watch how your heart rate responds to each. A brief slowing indicates that the network linking the front of the brain to the vagus nerve has engaged, and the site producing the clearest slowing is the site we treat.

The method is grounded in published research, including work from our own scientific advisor. We believe we are the first clinic in London to make it standard practice for every patient. It is a way of choosing a target, not a treatment in itself, and the evidence for the treatment is set out on the rTMS pages.

Areas treated

Why the target is measured, not assumed

Your target is chosen from your own physiology rather than from a fixed scalp measurement
The check is objective: a heart rate response either appears at a site or it does not
Testing happens before a course starts, so weeks are not spent stimulating the wrong place
Grounded in published research, including work from our own scientific advisor
Non-invasive, and part of the appointment rather than a separate procedure
A clear answer when no site responds well, which is information worth having early

Patient journey

What the targeting session involves

Consultation & preparation

Come as you would to any appointment, and take your usual medication unless your clinician has said otherwise. Two things genuinely affect the reading, so both are worth planning: keep caffeine to your ordinary amount rather than skipping it or doubling it, and avoid alcohol the night before, since it lowers the seizure threshold as well as altering heart rate. Leave earrings and hair clips out and skip heavy hair product, because the coil needs flat contact with the scalp. Tell us about any metal in your head, any implanted cardiac device and any heart rhythm condition before the appointment.

During treatment

Why heart rate says something about the brain

The vagus nerve is the main nerve of the parasympathetic nervous system, and it carries the signals that slow the heart. Circuits at the front of the brain connect into that system. So when stimulation engages those circuits, a brief slowing of heart rate is a readable signal from outside the body that something inside it responded.

Testing the candidate sites

Several positions over the dorsolateral prefrontal cortex are tested in turn, each with a short run of pulses while your heart rate is recorded. The comparison is between your own sites, not against a population average. It is done once, before your course, and it is not painful.

Choosing the one we treat

The site producing the clearest heart-rate deceleration becomes your treatment target for the course. Your dose is set separately, as a percentage of your own motor threshold. Between them, the two measurements mean both where and how hard are answers taken from you rather than from a protocol sheet.

Where the research comes from

The approach is grounded in published research, including work from our own scientific advisor. Professor Alexander Sack advises the clinic, and The Telegraph described him in March 2026 as "a global leader in neuromodulation who directs the Academy of Brain Stimulation, advises Naya Health and trains their clinicians". We believe we are the first clinic in London to make this standard practice for every patient.

What it does not tell you

This is a targeting method. A clear heart response indicates that a circuit engaged; it does not predict that your symptoms will improve, and it is not a diagnostic finding. Whether treatment is working is a separate question, answered later by repeating your NayaScore and by how you actually feel.

Aftercare

Nothing is required afterwards and you can drive, work and exercise as normal. Your chosen target is recorded and used for the whole course, so the testing is not repeated at every session. Mild scalp tenderness is possible and settles quickly. Your clinician will tell you which site was selected and how clear the response was, including when it was less clear than they would like, because that changes what you should expect from the course.

Written and medically reviewed byNaya, Precision neuromodulation clinic · NCBI Bookshelf, StatPearls: physiology of the autonomic nervous system, on vagal control of heart rate.

FAQ

Neurocardiac targeting questions

How do you decide where to put the coil?

By testing. Several candidate sites over the dorsolateral prefrontal cortex are stimulated briefly while your heart rate is recorded, and the site producing the clearest slowing becomes your target. The comparison is between your own sites rather than against a population average or a fixed scalp measurement.

Why would my heart rate tell you anything about my brain?

Because the vagus nerve carries the signals that slow the heart, and circuits at the front of the brain connect into that system. A brief slowing after stimulation indicates those circuits engaged. It is an indirect signal, readable from outside the body, which is exactly what makes it useful in a clinic room.

Is this an established method?

It is grounded in published research, including work from our own scientific advisor, and we believe we are the first clinic in London to make it standard practice for every patient. It is not named in NICE guidance. That is an honest description of where a developing method currently sits.

Does the targeting session hurt, and how long does it take?

It feels like the treatment itself, a light tapping against the scalp, and most people find it unremarkable. It happens once, before your course begins, and adds time to that appointment rather than requiring a separate visit. Your motor threshold is usually measured in the same sitting.

What if none of the sites produce a clear response?

Then you find that out before you have paid for a course rather than after, which is one of the reasons for testing at all. Your clinician will talk through what it means for you, which may be a different target, a different approach, or a recommendation that stimulation is not the right treatment.

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