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Heart Rate Variability (HRV)

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Heart Rate Variability (HRV) xp l & E erim ca en i t in a l l C Journal of Clinical and Experimental C f a o r d l i a o Panday et al., J Clin Exp Cardiolog 2018, 9:4 n l o r g u y o Cardiology DOI: 10.4172/2155-9880.1000583 J ISSN: 2155-9880 Review Open Access Heart Rate Variability (HRV) Karishma Rajbhandari Panday1* and Dipesh Raj Panday2 1Department of Basic and Clinical Physiology, BP Koirala Institute of Health Sciences (BPKIHS), Nepal 2Department of Clinical Pharmacology and Therapeutics, BP Koirala Institute of Health Sciences (BPKIHS), Nepal *Corresponding author: Karishma Rajbhandari Panday, Assistant Professor, Department of Basic and Clinical Physiology, BP Koirala Institute of Health Sciences (BPKIHS), Nepal, Tel: + 9779862124700; E-mail: [email protected] Received date: March 22, 2018; Accepted date: April 17, 2018; Published date: April 24, 2018 Copyright: © 2018 Panday KR, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Heart rate is mainly determined by pacemaker current generated in the SA node. It, in turn, is regulated by autonomic nervous system. Sympathetic stimulation enhances chronotropic, ionotropic and dromotropic activity via α and β receptor activation whereas, parasympathetic stimulation causes reverse effect on heart via the M2 receptors. Varied input from these two branches of the ANS produces change in heart rate. So, HRV, therefore, is the change in the time interval between two consecutive heartbeats. In other words, HRV is the time difference between a given heart beat to the mean duration of heartbeat. Like all other organs of the body, heart is also susceptible to aging and diseases. These conditions influence heart rate and also HRV. Today, HRV has invited much investigation and debate. Electronic databases Google Scholar , IMSEAR (Index Medicus for South-East Asia Region), Scopemed and MEDLINE/ PubMed were extensively explored with key words “HRV” or “Heart Rate Variability” from earliest possible date (1973) to December, 2016 and the available information summarized. Different aspects of HRV have been covered including historical background, HRV Analysis Methods, Interpretation of HRV, software’s used for HRV recording, importance of HRV measurement, HRV in varying conditions, drugs etc. HRV offers a relatively simple, well-tolerated, and inexpensive method for studying physiological and pathophysiological processes in a noninvasive manner. However, there are several important challenges in this area of study. There are a number of confounding variables which contribute to HRV data collection and interpretation open to question. Again, one should not compare one’s HRV with others, since HRV is affected by numerous internal and external factors, namely, age, lifestyle, hormones, body functions etc. Keywords: Heart rate; Respiratory Sinus Arrhythmias; Cardiac heart beat rate is 60 beats per minute, each heart beat may not have diseases; Medications precisely occurred in each second. It may be such that one heart beat might have occurred at 960 ms and the other at 1112 ms. Difference of Introduction each with the “mean value” say 1000 ms gives HRV of 40 ms and 12 ms respectively for those two beats. HRV, thus, refers to beat-to-beat Heart rate is mainly determined by pacemaker current generated in changes in the heart rate [7]. the SA node [1]. It is regulated by ANS, which is mediated through nucleus tractus solitaries (NTS) situated in the brainstem (medulla). Other names of HRV are inter-beat intervals, R-R intervals, N-N NTS collects sensory information from chemoreceptors, baroreceptors, intervals, heart period variability, RR variability, cycle length variability muscle afferents, circulating hormones [2] and send autonomic etc. This variability is perfectly normal and is, infact, desirable. If the (involuntary) control to heart and blood vessels via sympathetic and heartbeat intervals are constant, HRV is considered to be low; and if parasympathetic nerves. Sympathetic stimulation enhances the length varies, then HRV is considered to be high [8]. chronotropic, ionotropic and dromotropic activity via α and β receptor Like all other organs of the body, heart is also susceptible to aging activation whereas, parasympathetic stimulation causes reverse effect and diseases. These conditions influence the heart rate and also the on heart via the M2 receptors. Variation in the output of these two heart rate variability. This, variation in HRV may point out current branches of the autonomic system produces variability in chronicity of disease or impending cardiac and other systemic diseases. Thus, the heart [3,4]. Thus, this variability in heart rate is a physiologic measurement of HRV offer a prognostic plus diagnostic tool in phenomenon and is a reflection of the cardiac modulation by the ANS different forms of illnesses [9–13]. [5].Lately, prefrontal cortical activities have also been linked to modulate heart rate [6]. Today, HRV has become the subject of active investigation and debate [14,15]. So, this is the authors’ endeavor to summarize an So, HRV is a variation in the time interval between heartbeats. In extensive literature review on HRV and its potential uses presented in other words, HRV is the time difference between a given heart beat to different electronic publications. the mean duration of heartbeat. It is different from Heart beat rate. If J Clin Exp Cardiolog, an open access journal Volume 9 • Issue 4 • 1000583 ISSN:2155-9880 Citation: Panday KR and Panday DR (2018) Heart Rate Variability (HRV). J Clin Exp Cardiolog 9: 583. doi:10.4172/2155-9880.1000583 Page 2 of 12 Materials and Methods artifacts and ectopic beats as these are left out of the triangle and also requires reasonable number of NN intervals to generate it. Time Electronic databases Google Scholar, IMSEAR (Index Medicus for domain measures are simple to compute but lack the ability to South-East Asia Region), Scopemed and MEDLINE/ PubMed were discriminate between different components of ANS on HRV. extensively explored with terms “HRV” or “Heart Rate Variability” from earliest date (1973) to December of 2016. Articles written in any Frequency-domain:Frequency domain measures use bands of language especially those published in contemporary years were given frequency and then count number of RR intervals that match the priority. For articles published in other languages than English, only bands. For 2–5 mins recording, three main peaks are recognized i.e. abstracts were reviewed. Very low frequency (VLF) <0.04 Hz, Low frequency (LF), 0.04 – 0.15 Hz, and High frequency (HF) 0.15 – 0.4 Hz. A fourth peak, Ultra-low Discussion frequency (ULF) 0.003–0.04 Hz, is generated if measured for 24 hours. It was the Task Force analysis which split heart rhythm oscillations into those four frequency bands. It also stated that the analysis must be Historical background done for five minute segments [21]. In 1733, the Rev. Stephen Hales reported for the first time that beat- Power spectral density (PSD) is another method of analysis which to-beat heart rate interval and blood pressure measured from arteries gives fundamental information on the power distribution. Discrete vary during the respiratory cycle [16]. After 100 years, Carl Ludwig Fourier transform is one of the most commonly used PSD methods used kymograph to record the first periodic changes in the amplitude whereas, Lomb–Scargle (LS) periodogram is one of the most and time of the pressure waves which varied along with respiration. He appropriate PSD estimation method [22]. observed that pulse interval elevated during inspiration and decreased during expiration, which was the first documented report which later Non-linear methods: There is increasing evidence to suggest that the was known as the Respiratory Sinus Arrhythmia (RSA) [17]. heart is not a periodic oscillator under normal physiologic conditions [23] and the commonly employed moment statistics of HRV may not With advent ECG, it became possible to detect beat-to-beat be able to detect subtle, but important changes in HR in time series. variations in the cardiac rhythm. The clinical importance of HRV was Therefore, several new analysis method of HR behavior, motivated by identified in 1963, when investigators found that just earlier to fetal nonlinear dynamics and chaos theory, have been developed to quantify death, variations in beat-to-beat length were detectable even prior to the dynamics of HR fluctuations [24,25]. In other words, the the variations in the heart rate itself. Again, HRV was reported to have cardiovascular system is very complex to be of a linear nature, so the prognostic value in 1987 since decreased HRV was correlated with only way one can comprehend HRV is by using nonlinear methods as decreased survival in myocardial infarction [18]. they offer more valid interpretations of ANS activity and is less sensitive to confounders [19]. HRV Analysis Methods The Poincaré plot is the most commonly used non-linear method of There are different ways by which HRV can be analyzed. More analyzing HRV. Each data point represents a pair of consecutive beats, commonly it can be measured in two ways i.e. as the alterations in time the x-axis represents the current NN interval, while the y-axis between two serial R waves on an ECG (‘Time domain measures’) or as represents the previous NN interval [19]. breaking down of the wave form of ECG-RR intervals into frequency power bands using spectral analysis [19,20]. Interpretation of HRV Time-domain: HRV is actually an umbrella term for many different calculations • SDNN (standard deviation of RR intervals), is often calculated in a and analysis methods. While there is wide agreement about the 24-hour duration. It represents total alteration. interpretation of these measures, there remains some debate about the • SDANN (standard deviation of the average RR intervals), is precise implications of each parameter [26].
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