Normal Values of Corrected Heart-Rate Variability in 10-Second Electrocardiograms for All Ages.

Marten E Van Den Berg,Hans Hillege,Gerard Van Herpen,Maartje N Niemeijer,Albert Hofman,Mark Eijgelsheim,Cees A Swenne,Michiel L Bots,Bruno H Stricker,Jan A Kors,Peter R Rijnbeek

doi:10.3389/fphys.2018.00424

Abstract

Purpose: Heart-rate variability (HRV) measured on standard 10-s electrocardiograms (ECGs) has been associated with increased risk of cardiac and all-cause mortality, but age- and sex-dependent normal values have not been established. Since heart rate strongly affects HRV, its effect should be taken into account. We determined a comprehensive set of normal values of heart-rate corrected HRV derived from 10-s ECGs for both children and adults, covering both sexes.Methods: Five population studies in the Netherlands (Pediatric Normal ECG Study, Leiden University Einthoven Science Project, Prevention of Renal and Vascular End-stage Disease Study, Utrecht Health Project, Rotterdam Study) provided 10-s, 12-lead ECGs. ECGs were stored digitally and analyzed by well-validated analysis software. We included cardiologically healthy participants, 42% being men. Their ages ranged from 11 days to 91 years. After quality control, 13,943 ECGs were available. Heart-rate correction formulas were derived using an exponential model. Two time-domain HRV markers were analyzed: the corrected standard deviation of the normal-to-normal RR intervals (SDNNc) and corrected root mean square of successive RR-interval differences (RMSSDc).Results: There was a considerable age effect. For both SDNNc and RMSSDc, the median and the lower limit of normal decreased steadily from birth until old age. The upper limit of normal decreased until the age of 60, but increased markedly after that age. Differences of the median were minimal between men and women.Conclusion: We report the first comprehensive set of normal values for heart-rate corrected 10-s HRV, which can be of value in clinical practice and in further research.

Highlights

MATERIALS AND METHODSHeart-rate variability (HRV) as measured on the electrocardiogram (ECG) is the variability of intervals between QRS complexes generated by sinus node depolarization in one continuous recording (Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology, 1996)
We report the first comprehensive set of normal values for heart-rate corrected 10-s HRV, which can be of value in clinical practice and in further research
Our study shows that in both men and women, the lower limit of normal (LLN) of SDNNc and RMSSDc decreases continuously from birth to old age, whereas the upper limit of normal (ULN) decreases at the same rate until the age of 50–60 and starts to rise again

Summary

Introduction

MATERIALS AND METHODSHeart-rate variability (HRV) as measured on the electrocardiogram (ECG) is the variability of intervals between QRS complexes generated by sinus node depolarization in one continuous recording (Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology, 1996). As a matter of fact, time-domain HRV markers as measured on 10-s ECGs have been associated with heart failure (Rautaharju et al, 2006), cardiac mortality (de Bruyne et al, 1999), and all-cause mortality (Dekker et al, 1997) in population-based studies. In one of these studies (de Bruyne et al, 1999), both high HRV and low HRV were associated with adverse outcomes. 10-s HRV seems a possible tool in epidemiological research and risk assessment

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