Heart rate variability measurements and the prediction of ventricular arrhythmias

Abstract

Heart rate variability (HRV) is the temporal variation between sequences of consecutive heartbeats. On a standard electrocardiogram (ECG), the maximum upwards deflection of a normal QRS complex is at the peak of the R wave (Figure 1), and the duration between two adjacent R wave peaks is termed the R-R interval. The ECG signal requires editing before HRV analysis can be performed, a process requiring the removal of all non-sinus-node-originating beats. The resulting period between adjacent QRS complexes resulting from sinus node depolarizations is termed the N-N (normal-normal) interval.1 HRV is the measurement of the variability of the N-N intervals. Figure 1. The normal electrocardiogram with component waves labelled. Although counter-intuitive, it is possible that HRV confers a survival advantage. Any system exhibiting intrinsic variability is primed to respond rapidly and appropriately to demands placed upon it. HRV is a measure of the balance between sympathetic mediators of heart rate (HR) (i.e. the effect of epinephrine and norepinephrine, released from sympathetic nerve fibres, acting on the sino-atrial and atrio-ventricular nodes), which increase the rate of cardiac contraction and facilitate conduction at the atrio-ventricular node, and parasympathetic mediators of HR (i.e. the influence of acetylcholine, released by the parasympathetic nerve fibres, acting on the sino-atrial and atrio-ventricular nodes), leading to a decrease in the HR and a slowing of conduction at the atrio-ventricular node. Sympathetic mediators appear to exert their influence over longer time periods and are reflected in the low frequency power (LFP) of the HRV spectrum (between 0.04 Hz and 0.15 Hz.2,,3 Vagal mediators exert their influence more quickly on the heart, and principally affect the high frequency power (HFP) of the HRV spectrum (between 0.15 Hz and 0.4 Hz).4 Thus, at any point in time, the LFP:HFP ratio is a proxy for the sympatho-vagal balance. Physiological and pathological process … Address correspondence to Dr M.J. Reed, Emergency Department, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA. e-mail: mattreed1{at}hotmail.com