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Heart Rate Variability

The phenomenon that is the focus of this report is the oscillation in the interval between consecutive heart beats as well as the oscillations between consecutive instantaneous heart rates. ‘Heart Rate Variability’ has become the conventionally accepted term to describe variations of both instantaneous heart rate and RR intervals. In order to describe oscillation in consecutive cardiac cycles, other terms have been used in the literature, for example cycle length variability, heart period variability, RR variability and RR interval tachogram, and they more appropriately emphasize the fact that it is the interval between consecutive beats that is being analysed rather than the heart rate per sec.

During the 1970s, Ewing et al. devised a number of simple bedside tests of short-term RR divergences to detect autonomic neuropathy in diabetic patients. The association of higher risk of post-infarction mortality with reduced HRV was first shown by Wolf et al. In 1977. In 1981, Akselrod et al. introduced power spectral analysis of heart rate fluctuations to quantitatively evaluate beat-to-beat cardiovascular control.

These frequency–domain analyses contributed to the understanding of the autonomic background of RR interval fluctuations in the heart rate record. The clinical importance of HRV became apparent in the late 1980s when it was confirmed that HRV was a strong and independent predictor of mortality following an acute myocardial infarction. With the availability of new, digital, high frequency, 24-h multi-channel electrocardiographic recorders, HRV has the potential to provide additional valuable insight into physiological and pathological conditions and to enhance risk stratification.

Variations in heart rate may be evaluated by a number of methods. Perhaps the simplest to perform are the time domain measures. With these methods either the heart rate at any point in time or the intervals between successive normal complexes are determined. In a continuous electrocardiographic (ECG) record, each QRS complex is detected, and the so-called normal-to-normal (NN) intervals (that is all intervals between adjacent QRS complexes resulting from sinus node depolarizations), or the instantaneous heart rate is determined. Simple time–domain variables that can be calculated include the mean NN interval, the mean heart rate, the divergence between the longest and shortest NN interval, the divergence between night and day heart rate, etc. Other time–domain measurements that can be used are variations in instantaneous heart rate secondary to respiration, tilt, Valsalva manoeuvre, or secondary to phenylephrine infusion. These divergences can be described as either divergences in heart rate or cycle length.

The autonomic nervous system response to athletic training and rehabilitative exercise programs after various disease states is thought to be a conditioning phenomenon. HRV data should be useful in understanding the chronological aspects of training and the time to optimal conditioning as it relates to the autonomic influences on the heart.