Heart Rate Variability

Reduced heart rate variability carries an adverse prognosis in patients who have survived an acute myocardial infarction. This article reviews the physiology, technical problems of assessment, and clinical relevance of heart rate variability. The sympathovagal influence and the clinical assessment of heart rate variability are discussed. Methods measuring heart rate variability are classified into four groups, and the advantages and disadvantages of each group are described. Concentration is on risk stratification of postmyocardial infarction patients. The evidence suggests that heart rate variability is the single most important predictor of those patients who are at high risk of sudden death or serious ventricular arrhythmias.

[1]  Hon Eh,et al.  ELECTRONIC EVALUATION OF THE FETAL HEART RATE. VIII. PATTERNS PRECEDING FETAL DEATH, FURTHER OBSERVATIONS. , 1963 .

[2]  E. Hon,et al.  ELECTRONIC EVALUATION OF THE FETAL HEART RATE. VIII. PATTERNS PRECEDING FETAL DEATH, FURTHER OBSERVATIONS. , 1963, American journal of obstetrics and gynecology.

[3]  J. Bendat,et al.  Measurement and Analysis of Random Data , 1968 .

[4]  A Malliani,et al.  A sympathetic reflex elicited by experimental coronary occlusion. , 1969, The American journal of physiology.

[5]  A. Malliani,et al.  Spinal sympathetic reflexes initiated by coronary receptors , 1971, The Journal of physiology.

[6]  M. N. Levy Brief Reviews: Sympathetic-Parasympathetic Interactions in the Heart , 1971, Circulation research.

[7]  P. Young,et al.  Time series analysis, forecasting and control , 1972, IEEE Transactions on Automatic Control.

[8]  A. Malliani,et al.  Nervous activity of afferent cardiac sympathetic fibres with atrial and ventricular endings , 1973, The Journal of physiology.

[9]  H. Luczak,et al.  An analysis of heart rate variability. , 1973, Ergonomics.

[10]  A Malliani,et al.  A Cardiocardiac Sympathovagal Reflex in the Cat , 1973, Circulation research.

[11]  H. Akaike A new look at the statistical model identification , 1974 .

[12]  F R Calaresu,et al.  Influence of cardiac neural inputs on rhythmic variations of heart period in the cat. , 1975, The American journal of physiology.

[13]  P G Katona,et al.  Respiratory sinus arrhythmia: noninvasive measure of parasympathetic cardiac control. , 1975, Journal of applied physiology.

[14]  B Lown,et al.  Neural activity and ventricular fibrillation. , 1976, The New England journal of medicine.

[15]  Q. Regestein,et al.  Basis for recurring ventricular fibrillation in the absence of coronary heart disease and its management. , 1976, The New England journal of medicine.

[16]  G. Varigos,et al.  Sinus Arrhythmia in Acute Myocardial Infarction , 1978, The Medical journal of Australia.

[17]  F. Harris On the use of windows for harmonic analysis with the discrete Fourier transform , 1978, Proceedings of the IEEE.

[18]  H. Brown,et al.  How does adrenaline accelerate the heart? , 1979, Nature.

[19]  D. Ewing,et al.  The natural history of diabetic autonomic neuropathy. , 1980, The Quarterly journal of medicine.

[20]  J. Hirsch,et al.  Respiratory sinus arrhythmia in humans: how breathing pattern modulates heart rate. , 1981, The American journal of physiology.

[21]  S.M. Kay,et al.  Spectrum analysis—A modern perspective , 1981, Proceedings of the IEEE.

[22]  R. Cohen,et al.  Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat-to-beat cardiovascular control. , 1981, Science.

[23]  Alberto Malliani,et al.  Cardiovascular sympathetic afferent fibers , 1982 .

[24]  T. Musha,et al.  1/f Fluctuation of Heartbeat Period , 1982, IEEE Transactions on Biomedical Engineering.

[25]  S. Smith Reduced sinus arrhythmia in diabetic autonomic neuropathy: diagnostic value of an age-related normal range. , 1982, British medical journal.

[26]  W. Trautwein,et al.  Acetylcholine activation of single muscarinic K+ channels in isolated pacemaker cells of the mammalian heart , 1983, Nature.

[27]  D L Eckberg,et al.  Human sinus arrhythmia as an index of vagal cardiac outflow. , 1983, Journal of applied physiology: respiratory, environmental and exercise physiology.

[28]  D. Ewing,et al.  New method for assessing cardiac parasympathetic activity using 24 hour electrocardiograms. , 1984, British heart journal.

[29]  J. Strackee,et al.  Comparing Spectra of a Series of Point Events Particularly for Heart Rate Variability Data , 1984, IEEE Transactions on Biomedical Engineering.

[30]  R. Tarazi,et al.  Assessment of parasympathetic control of heart rate by a noninvasive method. , 1984, The American journal of physiology.

[31]  D. Adam,et al.  Assessment of autonomic function in humans by heart rate spectral analysis. , 1985, The American journal of physiology.

[32]  D. Ewing,et al.  The Value of Cardiovascular Autonomic Function Tests: 10 Years Experience in Diabetes , 1985, Diabetes Care.

[33]  R. Cohen,et al.  Hemodynamic regulation: investigation by spectral analysis. , 1985, The American journal of physiology.

[34]  F. Witkowski,et al.  Mechanisms controlling cardiac autonomic function and their relation to arrhythmogenesis , 1986 .

[35]  I. O'Brien,et al.  Heart rate variability in healthy subjects: effect of age and the derivation of normal ranges for tests of autonomic function. , 1986, British heart journal.

[36]  M. Turiel,et al.  Power Spectral Analysis of Heart Rate and Arterial Pressure Variabilities as a Marker of Sympatho‐Vagal Interaction in Man and Conscious Dog , 1986, Circulation research.

[37]  M. Kameyama,et al.  Intracellular control of calcium and potassium currents in cardiac cells. , 1986, Japanese heart journal.

[38]  R. Cohen,et al.  An Efficient Algorithm for Spectral Analysis of Heart Rate Variability , 1986, IEEE Transactions on Biomedical Engineering.

[39]  Glenn A. Myers,et al.  Power Spectral Analysis of Heart Rate Varability in Sudden Cardiac Death: Comparison to Other Methods , 1986, IEEE Transactions on Biomedical Engineering.

[40]  M. Mazzanti,et al.  Properties of the hyperpolarizing‐activated current (if) in cells isolated from the rabbit sino‐atrial node. , 1986, The Journal of physiology.

[41]  C. Hesdorffer,et al.  The possible etiology of the vibratory systolic murmur , 1987, Clinical cardiology.

[42]  J. Miller,et al.  Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. , 1987, The American journal of cardiology.

[43]  S Cerutti,et al.  Heart rate variability as an index of sympathovagal interaction after acute myocardial infarction. , 1987, The American journal of cardiology.

[44]  D H Singer,et al.  Heart rate variability and sudden death secondary to coronary artery disease during ambulatory electrocardiographic monitoring. , 1987, The American journal of cardiology.

[45]  A. Malliani,et al.  Spectral analysis of heart rate variability in the assessment of autonomic diabetic neuropathy. , 1988, Journal of the autonomic nervous system.

[46]  R J Cohen,et al.  Analysis of long term heart rate variability: methods, 1/f scaling and implications. , 1988, Computers in cardiology.

[47]  P. Schwartz,et al.  Autonomic mechanisms and sudden death. New insights from analysis of baroreceptor reflexes in conscious dogs with and without a myocardial infarction. , 1988, Circulation.

[48]  R J Cohen,et al.  Assessment of autonomic regulation in chronic congestive heart failure by heart rate spectral analysis. , 1988, The American journal of cardiology.

[49]  M. Yacoub,et al.  The 24-hour heart rate behavior in long-term survivors of cardiac transplantation. , 1988, The American journal of cardiology.

[50]  D. DiFrancesco,et al.  Inhibition of the hyperpolarization‐activated current (if) induced by acetylcholine in rabbit sino‐atrial node myocytes. , 1988, The Journal of physiology.

[51]  J. Fleiss,et al.  Components of heart rate variability measured during healing of acute myocardial infarction. , 1988, The American journal of cardiology.

[52]  D N Ghista,et al.  Spectral analysis of heart rate variability following human heart transplantation: evidence for functional reinnervation. , 1988, Journal of the autonomic nervous system.

[53]  A. Malliani,et al.  Cardiovascular variability signals: towards the identification of a closed-loop model of the neural control mechanisms , 1988, IEEE Transactions on Biomedical Engineering.

[54]  D. DiFrancesco,et al.  Muscarinic control of the hyperpolarization‐activated current (if) in rabbit sino‐atrial node myocytes. , 1988, The Journal of physiology.

[55]  S. O’Grady,et al.  Cyclic nucleotide-mediated effects of ANF and VIP on flounder intestinal ion transport. , 1989, The American journal of physiology.

[56]  A. Camm,et al.  Heart rate variability in relation to prognosis after myocardial infarction: selection of optimal processing techniques. , 1989, European heart journal.

[57]  R J Cohen,et al.  Power spectrum analysis of heart rate variability in human cardiac transplant recipients. , 1989, Circulation.

[58]  J. Buring,et al.  An overview of randomized trials of rehabilitation with exercise after myocardial infarction. , 1989, Circulation.

[59]  R J Cohen,et al.  Beat to beat variability in cardiovascular variables: noise or music? , 1989, Journal of the American College of Cardiology.

[60]  H L Greene,et al.  Classification of deaths after myocardial infarction as arrhythmic or nonarrhythmic (the Cardiac Arrhythmia Pilot Study). , 1989, The American journal of cardiology.

[61]  J. Saul,et al.  Transfer function analysis of autonomic regulation. I. Canine atrial rate response. , 1989, The American journal of physiology.

[62]  J. Saul,et al.  Modulation of cardiac autonomic activity during and immediately after exercise. , 1989, The American journal of physiology.

[63]  G. Casolo,et al.  Decreased spontaneous heart rate variability in congestive heart failure. , 1989, The American journal of cardiology.

[64]  R.D. Berger,et al.  Assessment of autonomic response by broad-band respiration , 1989, IEEE Transactions on Biomedical Engineering.

[65]  Shaw-Jyh Shin,et al.  Assessment of autonomic regulation of heart rate variability by the method of complex demodulation , 1989, IEEE Transactions on Biomedical Engineering.

[66]  A Calciati,et al.  Evidence for an intrinsic mechanism regulating heart rate variability in the transplanted and the intact heart during submaximal dynamic exercise? , 1990, Cardiovascular research.

[67]  M Kumashiro,et al.  Power spectral analysis of heart rate variability in traumatic quadriplegic humans. , 1990, The American journal of physiology.

[68]  S Cerutti,et al.  Analysis of short-term oscillations of R-R and arterial pressure in conscious dogs. , 1990, The American journal of physiology.

[69]  S. Malpas,et al.  Heart-Rate Variability and Cardiac Autonomic Function in Diabetes , 1990, Diabetes.

[70]  M. Merri,et al.  Sampling frequency of the electrocardiogram for spectral analysis of the heart rate variability , 1990 .

[71]  M. Rosen,et al.  Sympathetic neural modulation of cardiac impulse initiation and repolarization in the newborn rat. , 1990, Circulation research.

[72]  H. T. Nagle,et al.  A comparison of the noise sensitivity of nine QRS detection algorithms , 1990, IEEE Transactions on Biomedical Engineering.

[73]  J. Kentish,et al.  Effects of changes of pH on the contractile function of cardiac muscle. , 1990, The American journal of physiology.

[74]  A J Camm,et al.  Significance of long term components of heart rate variability for the further prognosis after acute myocardial infarction. , 1990, Cardiovascular research.

[75]  M Malik,et al.  Circadian rhythm of heart rate variability after acute myocardial infarction and its influence on the prognostic value of heart rate variability. , 1990, The American journal of cardiology.

[76]  G. Isenberg,et al.  Acetylcholine activates nonselective cation channels in guinea pig ileum through a G protein. , 1990, The American journal of physiology.

[77]  C. Wientjes,et al.  A comparison of three quantification methods for estimation of respiratory sinus arrhythmia. , 1990, Psychophysiology.

[78]  J. Saul,et al.  Heart rate and muscle sympathetic nerve variability during reflex changes of autonomic activity. , 1990, The American journal of physiology.

[79]  J. Fleiss,et al.  Efficient estimation of the heart period power spectrum suitable for physiologic or pharmacologic studies. , 1990, The American journal of cardiology.

[80]  D. Y. Wang,et al.  Effect of norepinephrine on Na(+)-K+ pump and Na+ influx in sheep cardiac Purkinje fibers. , 1990, The American journal of physiology.

[81]  P. Schwartz,et al.  Sympathetic nervous system and cardiac arrhythmias , 1990 .

[82]  P. Macfarlane,et al.  Recommendations for standardization and specifications in automated electrocardiography: bandwidth and digital signal processing. A report for health professionals by an ad hoc writing group of the Committee on Electrocardiography and Cardiac Electrophysiology of the Council on Clinical Cardiology, , 1990, Circulation.

[83]  A. Malliani,et al.  Continuous 24-hour assessment of the neural regulation of systemic arterial pressure and RR variabilities in ambulant subjects. , 1990, Circulation.

[84]  E. Fallen,et al.  Diurnal variations of neurocardiac rhythms in acute myocardial infarction. , 1991, The American journal of cardiology.

[85]  J. Saul,et al.  Transfer function analysis of the circulation: unique insights into cardiovascular regulation. , 1991, The American journal of physiology.

[86]  J. Fleiss,et al.  Time course of recovery of heart period variability after myocardial infarction. , 1991, Journal of the American College of Cardiology.

[87]  R J Cohen,et al.  Spectral analysis of heart rate in diabetic autonomic neuropathy. A comparison with standard tests of autonomic function. , 1991, Archives of neurology.

[88]  P. Binkley,et al.  Parasympathetic withdrawal is an integral component of autonomic imbalance in congestive heart failure: demonstration in human subjects and verification in a paced canine model of ventricular failure. , 1991, Journal of the American College of Cardiology.

[89]  A. Malliani,et al.  Cardiovascular Neural Regulation Explored in the Frequency Domain , 1991, Circulation.

[90]  P. Schwartz,et al.  Single cardiac vagal fiber activity, acute myocardial ischemia, and risk for sudden death. , 1991, Circulation research.

[91]  Peter J. Schwartz,et al.  Heart rate variability in patients with ventricular arrhythmias: Effect of antiarrhythmic drugs , 1991 .

[92]  R. Hughson,et al.  Coarse-graining spectral analysis: new method for studying heart rate variability. , 1991, Journal of applied physiology.

[93]  M. Chung,et al.  Stability over time of variables measuring heart rate variability in normal subjects. , 1991, The American journal of cardiology.

[94]  J M Neilson,et al.  Twenty four hour heart rate variability: effects of posture, sleep, and time of day in healthy controls and comparison with bedside tests of autonomic function in diabetic patients. , 1991, British heart journal.

[95]  D. Singer,et al.  Reproducibility and relation to mean heart rate of heart rate variability in normal subjects and in patients with congestive heart failure secondary to coronary artery disease. , 1991, The American journal of cardiology.

[96]  O Odemuyiwa,et al.  Comparison of the predictive characteristics of heart rate variability index and left ventricular ejection fraction for all-cause mortality, arrhythmic events and sudden death after acute myocardial infarction. , 1991, The American journal of cardiology.

[97]  S Cerutti,et al.  Altered pattern of circadian neural control of heart period in mild hypertension. , 1991, Journal of hypertension.

[98]  D DiFrancesco,et al.  The contribution of the ‘pacemaker’ current (if) to generation of spontaneous activity in rabbit sino‐atrial node myocytes. , 1991, The Journal of physiology.

[99]  M. Davies,et al.  Effect of quinapril on blood pressure and heart rate in congestive heart failure. , 1992, The American journal of cardiology.

[100]  F Lombardi,et al.  Beta-blocking effect of propafenone based on spectral analysis of heart rate variability. , 1992, The American journal of cardiology.

[101]  R. Burr,et al.  Comparison of heart rate variability in survivors and nonsurvivors of sudden cardiac arrest. , 1992, The American journal of cardiology.

[102]  A. Bakst,et al.  Effects of the dipyridamole test on left ventricular function in coronary artery disease. , 1992, The American journal of cardiology.

[103]  M. N. Levy,et al.  Sequence of excitation as a factor in sympathetic-parasympathetic interactions in the heart. , 1992, Circulation research.

[104]  J. Fleiss,et al.  Frequency Domain Measures of Heart Period Variability and Mortality After Myocardial Infarction , 1992, Circulation.

[105]  S Capewell,et al.  Decreased cardiac parasympathetic activity in chronic heart failure and its relation to left ventricular function. , 1992, British heart journal.

[106]  K M Kessler,et al.  Circadian rhythm of heart rate variability in survivors of cardiac arrest. , 1992, The American journal of cardiology.

[107]  P. Fratino,et al.  Impaired Circadian Modulation of Sympathovagal Activity in Diabetes: A Possible Explanation for Altered Temporal Onset of Cardiovascular Disease , 1992, Circulation.

[108]  A Malliani,et al.  Circadian variation of spectral indices of heart rate variability after myocardial infarction. , 1992, American heart journal.

[109]  G. Casolo,et al.  Heart rate variability during the acute phase of myocardial infarction. , 1992, Circulation.

[110]  J. Fleiss,et al.  Stability over time of heart period variability in patients with previous myocardial infarction and ventricular arrhythmias. The CAPS and ESVEM investigators. , 1992, The American journal of cardiology.

[111]  Claudio Cobelli,et al.  Power Spectral Analysis of Heart-Rate Variations Improves Assessment of Diabetic Cardiac Autonomic Neuropathy , 1992, Diabetes.

[112]  F Lombardi,et al.  Autonomic nervous system adaptations to short-term exercise training. , 1992, Chest.

[113]  M G Kienzle,et al.  Clinical, hemodynamic and sympathetic neural correlates of heart rate variability in congestive heart failure. , 1992, The American journal of cardiology.

[114]  H. Kennedy,et al.  Ambulatory (Holter) electrocardiography technology. , 1992, Cardiology clinics.

[115]  W. Trautwein,et al.  Relaxation of the ACh-induced potassium current in the rabbit sinoatrial node cell , 1978, Pflügers Archiv.

[116]  A. Noma,et al.  On the kinetics of the potassium channel activated by acetylcholine in the S-A node of the rabbit heart , 1980, Pflügers Archiv.

[117]  Time-domain system for assessing variation in heart rate , 1988, Medical and Biological Engineering and Computing.

[118]  S. Cerutti,et al.  Spectral analysis of heart rate variability signal and respiration in diabetic subjects , 1990, Medical and Biological Engineering and Computing.