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Heart Rate Variability July 2001 
18 recent abstracts of the 5600 papers in Pubmed responding to the search "heart rate variability"

Intraindividual analysis of instantaneous heart rate variability.
Psychophysiology 2001 Jul;38(4):659-68
Kettunen J, Keltikangas-Jarvinen L.

Department of Psychology, University of Helsinki, Finland. jokettunen@kihu.jyu.fi

We examined the use and potential of quantifying instantaneous heart rate variability (HRV) using a joint time-frequency and time-domain methods. These new techniques are promising, because they provide tools to quantify nonstationary, beat-by-beat changes in HRV components, and are therefore flexible with respect to the design of experimental protocols. A smoothed pseudo-Wigner-Ville distribution (SPWVD) and a time-domain index using polynomial filtering produced fairly coherent estimates of band-specific HRV amplitudes, whereas SPWVD yielded additional information on the frequency characteristics of HRV. Instantaneous HRV appeared to have a complex and a frequency-specific relationship to cardiac activity and electrodermal activity, It is concluded that the time-frequency analysis of HRV is a very promising method for mapping transient changes in the frequency and amplitude characteristics of cardiac dynamics.
Circadian variation of heart rate variability and the rate of autonomic change in the morning hours in healthy subjects and angina patients.
Int J Cardiol 2001 Jun;79(1):61-9
Wennerblom B, Lurje L, Karlsson T, Tygesen H, Vahisalo R, Hjalmarson A.

Division of Cardiology, Sahlgrenska University Hospital, S-413 45, Goteborg, Sweden
Background: Incidence of sudden cardiac death peaks during the early morning hours when there is a rapid withdrawal of vagal and an increase of sympathetic tone. The rate of autonomic change could be of prognostic importance. Patients and methods: A total of 65 patients with angina pectoris, free from other diseases and drug free, were Holter monitored for 24 h. A total of 30 patients were also monitored on isosorbide-5-mononitrate (IS-5-MN) and on metoprolol respectively. A total of 33 age-matched healthy subjects served as controls. Spectral components of heart rate variability (HRV) were analysed hourly, with special reference to the rapid changes of autonomic tone during the night and early morning hours. Circadian variation was assessed in two ways: (1) Mean HRV day (8 a.m.-8 p.m.) and night (0-5 a.m.) were compared. (2) For the morning/night hours (0-10 a.m.), individual hourly values for max. and min. HRV, the difference max.-min. (gradient), the rate of change per hour between max. and min. (velocity) and the largest difference between two consecutive hours (max. velocity) were recorded and the mean value for the group calculated. Results: During the night/morning hours, healthy controls demonstrated faster HF max. velocity (P=0.002) and higher HF gradient (P=0.011) than angina patients. Metoprolol and IS-5-MN increased the HF gradient (P=0.008 and P=0.003, respectively), and metoprolol tended to increase the max. velocity (P=0.02). Metoprolol substantially decreased the LF/HF gradient (P=0.001), velocity (P=0.008) and max. velocity (P=0.0001). Conclusion: Rapid vagal withdrawal seemed to be a sign of a healthy autonomic nervous system in the control group but was significantly slower in angina patients. IS-5-MN and metoprolol tended to normalise vagal withdrawal and metoprolol slowed down the rapid increase in sympathetic predominance in the morning in patients.
Analysis of twenty-four hour heart rate variability in patients with panic disorder.

McCraty R, Atkinson M, Tomasino D, Stuppy WP.
Biol Psychol 2001 Jun;56(2):131-150
HeartMath Research Center, Institute of HeartMath, 14700 West Park Avenue, 95006, Boulder Creek, CA, USA

Growing evidence suggests that alterations in autonomic function contribute to the pathophysiology of panic disorder (PD). This retrospective study employed 24-h heart rate variability (HRV) analysis of Holter records to compare autonomic function in PD patients (n=38) with healthy, age- and gender-matched controls. Both time and frequency domain measures were calculated, and a circadian rhythm analysis was performed. The SDNN index, 5-min total power, very low frequency (VLF) and low frequency (LF) power were significantly lower in panic patients relative to controls over the 24-h period. Hourly means were significantly lower during some of the waking hours as well as the latter part of the sleep cycle. In contrast, the mean RR interval, RMSSD and high frequency (HF) power were comparable in patients and controls. Results suggest that sympathetic activity is depressed in PD patients under usual life conditions, leading to a relative predominance of vagal tone. Findings of low HRV in PD patients are consistent with the high rate of cardiovascular morbidity and mortality in this population, as well as with the emerging view of panic as a disorder involving reduced flexibility and adaptability across biological, affective and behavioral dimensions.

Temporal age-related changes in spectral, fractal and complexity characteristics of heart rate variability.

Jokinen V, Syvanne M, Makikallio TH, Airaksinen KE, Huikuri HV.
Clin Physiol 2001 May;21(3):273-81
Division of Cardiology, Department of Medicine, University of Oulu, Oulu, Finland.

Cross-sectional studies have suggested that heart rate (HR) variability, analysed using traditional time and frequency domain methods, is related to ageing, but no longitudinal studies have estimated the age dependence of HR fluctuation. This study evaluated temporal age-related changes in 12-h measures of HR variability among 109 patients with coronary artery disease (CAD), who underwent repeat Holter recordings at 32-month intervals. Time and frequency domain measures, along with fractal and complexity measures of HR variability, were determined at the baseline and after 32 months. Changes in HR dynamics were compared with various laboratory variables, exercise data and angiographic progression of CAD. Traditional time and frequency domain measures of HR variability did not change significantly during the follow-up, but the power-law scaling slope decreased from -1.29 +/- 0.20 to -1.36 +/- 0.23 (P<0.01) and the short-term fractal exponent (alpha1) of HR dynamics from 1.29 +/- 0.14-1.22 +/- 0.18 (P<0.001). The approximate entropy value also decreased from 1.00 +/- 0.19 to 0.95 +/- 0.18 (P<0.05). The changes in HR behaviour were not related to demographic data, laboratory values or angiographic progression of CAD. Only a weak correlation was observed between the change in the power-law slope and the baseline glucose value (P<0.05). This longitudinal study shows that the fractal characteristics of HR dynamics and the complexity properties of R-R intervals undergo rapid changes along with ageing, and that fractal and complexity analysis techniques are more sensitive than traditional analysis methods in documenting temporal age-related changes in HR behaviour.

Role of antiarrhythmic therapy in patients at risk for sudden cardiac death: an evidence-based review.

Hilleman DE, Bauman AL.
Pharmacotherapy 2001 May;21(5):556-75
Department of Pharmacy Practice, Creighton University School of Pharmacy and Allied Health Professions, Omaha, Nebraska 68178, USA.

Sudden cardiac death (SCD) accounts for more than half of all cardiac deaths occurring each year in the United States. Although it has several causes, patients at greatest risk are those with coronary artery disease and impaired left ventricular function, heart failure secondary to ischemia or idiopathic dilated cardiomyopathy, hypertrophic cardiomyopathy, documented sustained ventricular tachycardia or ventricular fibrillation, and survivors of cardiac arrest. The presence of asymptomatic ventricular arrhythmias, positive signal-averaged electrocardiogram (ECG), low heart rate variability index, or inducible ventricular tachycardia or ventricular fibrillation increases the risk. In primary prevention trials in patients with ischemic heart disease, beta-blockers reduced both total mortality and SCD, whereas class I antiarrhythmic drugs, especially class IC, increased mortality. Among class III agents, d,l-sotalol and dofetilide have a neutral effect on mortality, whereas d-sotalol increases mortality. Amiodarone has a neutral effect on total and cardiac mortality but does reduce the risk of arrhythmic death and cardiac arrest. Three primary prevention trials in patients with ischemic heart disease were conducted with implantable cardioverter-defibrillators (ICDs). Patients with low ejection fractions (EFs), asymptomatic ventricular arrhythmias, and inducible ventricular tachycardia or ventricular fibrillation had significant reductions in total, cardiac, and arrhythmic death with ICDs compared with either no drug therapy or conventional antiarrhythmic agents. The ICDs did not reduce mortality in patients with low EFs and a positive signal-averaged ECG undergoing coronary bypass graft. In those with heart failure, beta-blockers reduced total and SCD mortality, but dofetilide and amiodarone had a neutral effect on mortality. In the secondary prevention of SCD, antiarrhythmic drugs alone generally are not thought to improve survival. In three trials in patients with documented sustained ventricular tachycardia or ventricular fibrillation, or survivors of SCD, ICDs reduced cardiac and arrhythmic mortality. Total mortality, however, was significantly reduced in only one of these trials. The role of antiarrhythmic drugs in secondary prevention of SCD is limited to patients in whom ICD is inappropriate or in combination with ICD. Antiarrhythmics can be given selectively with ICDs to decrease episodes of ventricular tachycardia or fibrillation to reduce ICD discharges, to suppress episodes of nonsustained ventricular tachycardia that trigger ICD discharges, to slow the rate of ventricular tachycardia to increase hemodynamic stability, to allow effective antitachycardia pacing, or to suppress supraventricular arrhythmias.

Prognostic value of heart rate variability in time domain analysis in congestive heart failure.

Boveda S, Galinier M, Pathak A, Fourcade J, Dongay B, Benchendikh D, Massabuau P, Fauvel JM, Senard JM, Bounhoure JP.
J Interv Card Electrophysiol 2001 Jun;5(2):181-7
Department of Cardiology, Rangueil University Hospital, Toulouse, France.

Aims: Analysis of heart rate variability is a noninvasive tool that allows to study autonomic control of the heart. Several studies have shown disturbed heart rate variability in patients with chronic heart failure (CHF). We sought to assess the prognostic value of time domain measures of heart rate variability in CHF.Methods and Results: We prospectively enrolled 190 patients with CHF in sinus rhythm, mean age 61+/-12 years, 109 (57.4 %) in NYHA class II and 81 (42.6 %) in class III or IV, mean cardiothoracic ratio 57.6+/-6.4 % and mean left ventricular ejection fraction 28.2+/-8.8 %, 85 (45 %) with ischemic and 105 (55 %) with idiopathic dilated cardiomyopathy. Time domain measures of heart rate variability were obtained from 24[emsp4 ]h Holter ECG recordings. During follow-up (22+/-18 months), 55 patients died. In multivariate analysis, independent predictors for all-cause mortality were: ischemic heart disease, cardiothoracic ratio >/=60 % and standard deviation of all normal RR intervals <67[emsp4 ]ms (RR=2.5, 95 % CI 1.5-4.2).Conclusions: Depressed heart rate variability has independent prognostic value in patients with CHF.

Prediction of sudden cardiac death by fractal analysis of heart rate variability in elderly subjects.

Makikallio TH, Huikuri HV, Makikallio A, Sourander LB, Mitrani RD, Castellanos A, Myerburg RJ.
J Am Coll Cardiol 2001 Apr;37(5):1395-402
Division of Cardiology, University of Miami, School of Medicine, Florida 33101, USA. Tmakikia@med.miami.edu


OBJECTIVES: The aim of this study was to test the hypothesis that abnormal scaling characteristics of heart rate (HR) predict sudden cardiac death in a random population of elderly subjects. BACKGROUND: An abnormality in the short-term fractal scaling properties of HR has been observed to be related to a risk of life-threatening arrhythmias among patients with advanced heart diseases. The predictive power of altered short-term scaling properties of HR in general populations is unknown. METHODS: A random sample of 325 subjects, age 65 years or older, who had a comprehensive risk profiling from clinical evaluation, laboratory tests and 24-h Holter recordings were followed up for 10 years. Heart rate dynamics, including conventional and fractal scaling measures of HR variability, were analyzed. RESULTS: At 10 years of follow-up, 164 subjects had died. Seventy-one subjects had died of a cardiac cause, and 29 deaths were defined as sudden cardiac deaths. By univariate analysis, a reduced short-term fractal scaling exponent predicted the occurrence of cardiac death (relative risk [RR] 2.5, 95% confidence interval [CI], 1.9 to 3.2, p < 0.001) and provided even stronger prediction of sudden cardiac death (RR 4.1, 95% CI, 2.5 to 6.6, p Y 0.001). After adjusting for other predictive variables in a multivariate analysis, reduced exponent value remained as an independent predictor of sudden cardiac death (RR 4.3, 95% CI, 2.0 to 9.2, p < 0.001). CONCLUSIONS: Altered short-term fractal scaling properties of HR indicate an increased risk for cardiac mortality, particularly sudden cardiac death, in the random population of elderly subjects.
Relative influence of age, resting heart rate and sedentary life style in short-term analysis of heart rate variability.

Migliaro ER, Contreras P, Bech S, Etxagibel A, Castro M, Ricca R, Vicente K.
Braz J Med Biol Res 2001 Apr;34(4):493-500
Laboratorio de Fisiologia Cardiovascular, Departamento de Fisiologia, Facultad de Medicina, Av. Gral Flores, 2125, 11800 Montevideo, Uruguay. erm@fmed.edu.uy

In order to assess the relative influence of age, resting heart rate (HR) and sedentary life style, heart rate variability (HRV) was studied in two different groups. The young group (YG) consisted of 9 sedentary subjects aged 15 to 20 years (YG-S) and of 9 nonsedentary volunteers (YG-NS) also aged 15 to 20. The elderly sedentary group (ESG) consisted of 16 sedentary subjects aged 39 to 82 years. HRV was assessed using a short-term procedure (5 min). R-R variability was calculated in the time-domain by means of the root mean square successive differences. Frequency-domain HRV was evaluated by power spectrum analysis considering high frequency and low frequency bands. In the YG the effort tolerance was ranked in a bicycle stress test. HR was similar for both groups while ESG showed a reduced HRV compared with YG. Within each group, HRV displayed a negative correlation with HR. Although YG-NS had better effort tolerance than YG-S, their HR and HRV were not significantly different. We conclude that HRV is reduced with increasing HR or age, regardless of life style. The results obtained in our short-term study agree with others of longer duration by showing that age and HR are the main determinants of HRV. Our results do not support the idea that changes in HRV are related to regular physical activity.
A population-based study on the determinants of heart rate and heart rate variability in the frequency domain.

Fagard RH.
Verh K Acad Geneeskd Belg 2001;63(1):57-89; discussion 90-1
Hypertension and Cardiovascular Rehabilitation Unit, Department of Molecular and Cardiovascular Research, Faculteit Geneeskunde, K.U.Leuven, U.Z. Gasthuisberg-Hypertensie, Herestraat 49-B 3000 Leuven.

The main objective of the present study was to identify the determinants of heart rate (HR) and of the low-frequency (LF) and high-frequency (HF) components of short-term heart rate variability (HRV) in the population. HF power represents vagal modulation of HRV and LF power predominantly sympathetic modulation. Data were collected in a population-based sample of 614 men and women, aged 25-89 years. Because of the uncertainty on the optimal methodology for power spectral analysis of HRV, we first compared the results obtained with the two most frequently used methods. We found that autoregressive modelling and fast Fourier transform yielded similar overall qualitative results, but that within subject differences between methods could be considerable. Results could also differ according to whether they were expressed in absolute (ms2) or in normalized (%) units. Age and gender significantly influenced HR and various components of HRV. Furthermore we observed significant interactions between age and gender regarding several components of HRV, indicating that men and women differ at younger age, but not after the age of about 50 yrs. Parasympathetic modulation appeared to be greater in women than in men at younger age, but not after the age of menopause. The changes of HR and HRV on standing were attenuated with increasing age. Influences of body mass index, smoking, alcohol consumption and habitual physical activity were small to negligible. In conclusion, the employed methodology and several demographic, anthropometric and/or lifestyle characteristics should be taken into account for the interpretation of HRV in cardiovascular disease.

Reduced heart rate variability in ischemic heart disease is only partially caused by ischemia. An HRV study before and after PTCA.

Wennerblom B, Lurje L, Solem J, Tygesen H, Uden M, Vahisalo R, Hjalmarson A.
Cardiology 2000;94(3):146-51
Department of Cardiology, Sahlgrenska University Hospital, S-413 35 Goteborg, Sweden. bertil.wennerblom@tripnet.se

BACKGROUND: Reduced heart rate variability (HRV) after acute myocardial infarction (AMI) indicates poor prognosis. HRV in patients with uncomplicated coronary artery disease is reduced, and an association with poor prognosis has been suggested. The mechanism of the HRV reduction is not known, but ischemia is a possibility. AIM: To evaluate, in angina patients with no prior AMI, no other disease and drug-free, if complete revascularization and thus important reduction of ischemia by means of PTCA influences HRV. PATIENTS AND METHODS: Twenty-four-hour Holter recordings were performed at baseline prior to PTCA in 48 patients with angina and in 41 age-matched healthy control subjects. The recording was repeated 1 and 6 months after complete revascularization. In addition, HRV was registered during controlled respiration in the supine and standing positions and during cold pressure test at baseline in all angina patients and controls and in 17 consecutive angina patients 6 months after PTCA. RESULTS: Compared to controls, angina patients had a significantly reduced mean RR interval (p = 0.02), SD (p = 0.003), rMSSD (p = 0.03), pNN50 (p = 0.03), total power (p = 0.003), low- (p = 0.004) and high-frequency peak (p = 0.04), but normal SDNN, SDANN and LF/HF. One and 6 months after PTCA, 42/46 and 32/40 follow-up patients, respectively, were free of angina. Six months after PTCA, there was a significant recovery of vagal modulation seen in the frequency domain during controlled respiration, but only nonsignificant trends in HRV parameters analyzed over 24 h. CONCLUSION: Patients with uncomplicated angina had reduced HRV, mainly affecting vagal activity, but normal low frequency variability associated with mortality. Complete revascularization caused a partial normalization of vagal modulation indicating that ischemia may be one of but not the only mechanism of the HRV reduction in uncomplicated chronic coronary artery disease.

Linear and non-linear 24 h heart rate variability in chronic heart failure.

Guzzetti S, Mezzetti S, Magatelli R, Porta A, De Angelis G, Rovelli G, Malliani A.
Auton Neurosci 2000 Dec 28;86(1-2):114-9
Centro Ricerche Cardiovascolari, CNR, Dipartimento Scienze Precliniche L.I.T.A. Vialba, Medicina Interna II, Ospedale L. Sacco, Universita degli Studi, Via GB Grassi 74, 20157 Milan, Italy. stefanog@fisiopat.sacco.unimi.it


It has recently been demonstrated that SDNN of heart rate variability (HRV) is a useful independent prognostic tool in chronic heart failure (CHF). The purpose of the present study was to evaluate if spectral and non-linear analysis of 24-h HRV, considered markers of autonomic cardiac modulation, contain independent prognostic information in CHF patients. Twenty normal subjects and thirty consecutive outpatients with clinically stable CHF were studied for 2 years. Periods of 300 R-R intervals were analyzed from Holter recordings. The power spectral analysis, the slope of the linear relationship between log-power versus log-frequency (1/f), and the complexity content (using corrected conditional entropy; CCE) of the R-R series were calculated. The normalized power of the low frequency spectral component (LF) and the 1/f slope were significantly lower in patients compared to controls (respectively 30.1 +/- 3.0 vs. 48.6 +/- 3.4 and -1.27 +/- 0.04 vs. -1.08 +/- 0.05; P < 0.05). Moreover, the patients who died during the study presented a reduced LF (20.9 +/- 4.1 vs. 35.5 +/- 3.5 nu; P < 0.05) and a steeper 1/f slope (-1.40 +/- 0.09 vs. -1.21 +/- 0.04 nuts, P < 0.05) compared to survivors. These results remained significant in a logistic model including heart rate and SDNN. The information content present in spectral and non-linear analysis of HRV in CHF patients has prognostic relevance independently from the time domain measures of HRV. In particular, the reduction of LF power seems the best indicator among those considered.

[Heart rate variability preceding the onset of atrial fibrillation].

[Article in German]

Wiegand UK, Bonnemeier H.
Herz 2001 Feb;26(1):49-54
Medizinische Klinik II, Medizinische Universitat zu Lubeck. uwe.wiegand@medinf.mu-luebeck.de

BACKGROUND: The occurrence of paroxysmal atrial fibrillation is related to changes in autonomic tone. Vagally mediated atrial fibrillation predominantly occurs at night in young male patients without history of structural heart disease. In contrast, sympathetically mediated atrial fibrillation is typically triggered by stress. ANALYSIS OF HEART RATE VARIABILITY: Heart rate variability usually measured by Holter monitoring can determine changes in autonomic tone immediately preceding the onset of atrial fibrillation. Studies on this topic found divergent results on the incidence of atrial fibrillation mediated by changes in autonomic tone. Dependent on the results of different studies, night-time episodes of idiopathic atrial fibrillation either are vagally or sympathetically mediated. A sympathetic predominance is found in patients after coronary bypass surgery, concordantly. The inconsistency of these findings points to the fact that not only one mechanism, but more complex changes in autonomic tone are responsible for the occurrence of atrial fibrillation in many cases. In modern pacemakers and implantable cardioverter-defibrillators, PP or RR intervals can be stored automatically before the onset of an arrhythmia. By use of these stored intervals, time-domain parameters of heart rate variability can be calculated. We determined changes in short-term heart rate variability (10-second intervals) by analyzing 26 episodes of PP intervals sampled over the last 2 minutes before onset of atrial fibrillation by a modern dual chamber pacemaker. We observed a significant increase of the standard deviation of PP intervals (SDNN10s) as well as of the mean square route of the squared PP intervals (rMSSD10s) within the last 10-second interval before onset of atrial fibrillation (p < 0.05). This finding points to changes in autonomic tone-immediately preceding the onset of atrial fibrillation. CONCLUSION: The preliminarity of these findings and the use of yet not validated short intervals for determination of heart rate variability does not allow to draw pathogenetic or even therapeutic conclusions from these findings.

Automatic computerized analysis of heart rate variability with digital filtering of ectopic beats.

Storck N, Ericson M, Lindblad L, Jensen-Urstad M.
Clin Physiol 2001 Jan;21(1):15-24

Department of Clinical Physiology, Soder Hospital, Karolinska Institute, Stockholm, Sweden.

Analysis of heart rate variability (HRV) has been used in studies of autonomic function and risk assessment in different patient groups such as in patients with diabetes mellitus, after myocardial infarction (MI) and other cardiovascular disease. Ectopic beats can, however, interfere with HRV analysis and give erroneous results. We have therefore studied the impact of ectopic beats on HRV analysis and the ability of a filter algorithm to correct this. Power spectral analysis of synthetic data with an increasing proportion of ectopic beats and 24-h Holter recordings from 98 healthy subjects and 93 post MI patients was done with and without digital filtering and interpolation of errors in the data stream. The analysis of HRV was seriously hampered by less than 1% of ectopic beats. A filter algorithm based on detection and linear interpolation of ectopic beats and other noise in the data stream corrected effectively for this in the synthetic data employed. In the healthy subjects and the post MI patients, filtering markedly reduced the extra variability related to non-normal beats. The software could automatically analyse over one hundred 24-h files in one batch. HRV analysis should include filtering for ectopic beats even with a small number of such beats. It is possible to make a fast analysis automatically even in huge clinical series, which makes it possible to use the method both clinically and in epidemiological studies.

Heart rate variability and early recurrence of atrial fibrillation after electrical cardioversion.

Lombardi F, Colombo A, Basilico B, Ravaglia R, Garbin M, Vergani D, Battezzati PM, Fiorentini C.
J Am Coll Cardiol 2001 Jan;37(1):157-62
Cardiologia, Dipartimento di Medicina, Chirurgia e Odontoiatria, Ospedale S. Paolo, Universita degli Studi di Milano, Milan, Italy. federico.lombardi@unimi.it


OBJECTIVES: The study evaluated the role of the autonomic nervous system in atrial fibrillation (AF) recurrence. BACKGROUND: Early recurrence of AF after cardioversion (CV) is attributed to electrical remodeling. The possibility that an abnormal autonomic modulation might contribute to this phenomenon has not yet been adequately tested. METHODS: We analyzed short-term heart rate variability (HRV) in 93 patients with persistent AF and on chronic amiodarone treatment, after restoration of sinus rhythm by electrical CV. RESULTS: Two weeks later, 25 patients presented with AF. Spectral analysis of HRV revealed that patients wi - - - -

Comment on:

  • Crit Care Med. 2000 Dec;28(12):3907-12

Heart rate variability and critical illness: potential and problems.

Goldstein B, Ellenby MS.
Crit Care Med 2000 Dec;28(12):3939-40

Publication Types:

  • Comment
  • Editorial
Sudden cardiac death: role of heart rate variability to identify patients at risk.

Lombardi F, Makikallio TH, Myerburg RJ, Huikuri HV.
Cardiovasc Res 2001 May;50(2):210-7

Cardiologia, Dipartimento di Medicina, Chirurgia e Odontoiatria, Ospedale S. Paolo, University of Milan, Milan, Italy.

Publication Types:
  • Review