INSIGHTS FROM THE STUDY OF HEART RATE VARIABILITY

• Published in: Annual review of medicine Vol. 50; no. 1; pp. 249 - 261
• Main Authors: Stein, PhD, P.K, Kleiger, MD, R.E
• Format: Journal Article
• Language: English
• Published: Palo Alto, CA 94303-0139 Annual Reviews 01.01.1999; 4139 El Camino Way, P.O. Box 10139 Annual Reviews, Inc; USA
• Subjects: Adult; Arrhythmias, Cardiac - physiopathology; Autonomic Nervous System - physiology; Autonomic Nervous System Diseases - physiopathology; Biological and medical sciences; cardiac autonomic modulation; Cardiac dysrhythmias; Cardiac Output - physiology; Cardiology. Vascular system; Circadian rhythm; Circadian Rhythm - physiology; Death, Sudden, Cardiac - etiology; Diabetic Neuropathies - physiopathology; Heart; Heart Conduction System - physiology; Heart Failure - physiopathology; Heart rate; Heart Rate - physiology; heart rate variability; Humans; Medical sciences; Mortality; Myocardial Infarction - physiopathology; Parasympathetic Nervous System - physiology; Predictive Value of Tests; Risk Factors; risk stratification; Sensitivity and Specificity; Survival Rate; Sympathetic Nervous System - physiology; Holter recording; Human; Heart rate; Electrodiagnosis; Arrhythmia; Heart disease; Modulation; Variability; Electrocardiography; Cardiovascular disease; Variance analysis
• ISSN: 0066-4219; 1545-326X
• DOI: 10.1146/annurev.med.50.1.249

Indices of heart rate variability (HRV) provide a window onto autonomic modulation of the heart. HRV indices, determined in either the time or frequency domain, are closely related and reflect parasympathetic, mixed sympathetic, and parasympathetic and circadian rhythms. In population studies, decreased HRV has had predictive value for mortality among healthy adults. It is a well-established risk factor for arrhythmic events and mortality among post-myocardial-infarction patients but has only moderate sensitivity and specificity. Decreased HRV has had mixed predictive success in congestive heart failure. Reduced HRV identifies diabetic patients with autonomic neuropathy. HRV in combination with other risk stratifiers, e.g. ejection fraction, can identify cardiac patients at especially high risk of mortality. Many but not all interventions associated with increased HRV are also associated with better survival rates.