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(Circulation. 2005;112:465-470.)
© 2005 American Heart Association, Inc.

Arrhythmia/Electrophysiology

Symbolic Dynamics of Heart Rate Variability

A Probe to Investigate Cardiac Autonomic Modulation

Stefano Guzzetti, MD; Ester Borroni, MD; Pietro E. Garbelli, MD; Elisa Ceriani, MD; Paolo Della Bella, MD; Nicola Montano, MD; Chiara Cogliati, MD; Virend K. Somers, MD; Alberto Mallani, MD; Alberto Porta, PhD

From Medicina Interna II and Dipartimento Scienze Cliniche, Ospedale "Luigi Sacco" (S.G., E.B., P.E.G., E.C., N.M., C.C., A.M.), and Dipartimento Scienze Precliniche, LITA di Vialba (A.P.), Universita’ degli Studi di Milano, Milano, Italy; Centro Cardiologico, Fondazione Monzino, Milano, Italy (P.D.B.); and Division of Cardiovascular Disease, Mayo Clinic College of Medicine, Rochester, Minn (V.K.S.).

Correspondence to Dr Stefano Guzzetti, Medicina Interna II, Ospedale "L. Sacco," Via GB Grassi 74, 20157 Milano, Italy. E-mail stefanog{at}fisiopat.sacco.unimi.it

Received November 3, 2004; revision received April 8, 2005; accepted April 12, 2005.

Background— Sympathetic and parasympathetic systems are considered the principal rapidly reacting systems that control heart rate.

Methods and Results— We propose a symbolic analysis series to quantify the prevalence of sympathetic or parasympathetic cardiac modulation. This analysis decomposes the heart rate variability series in patterns lasting 3 beats and classifies them into 3 categories: nonvariable, variable, and very variable patterns referred to as 0V, 1V, and 2V patterns. First, we applied this method to experimental and pharmacological conditions characterized by sympathetic activation (tilt test, handgrip, nitroprusside, and high-dose atropine administration) or parasympathetic activation (phenylephrine and low-dose atropine administration) in 60 healthy subjects. An increase in sympathetic modulation and a vagal withdrawal elicited a significant increase in 0V patterns and a decrease in 2V patterns, whereas parasympathetic dominance induced the opposite, reflecting a reciprocal sympathovagal balance. The second part of the study considered a series of 300 beats before the onset of major arrhythmic events in patients with an implantable cardioverter-defibrillator. Symbolic analysis detected an increase in the percentage of 0V patterns before the onset of major arrhythmias compared with baseline (41.6±3.9% and 24.4±2.9%, respectively; P<0.01), indicating a sympathetic prevalence. On the other hand, the 2V patterns did not decrease before major arrhythmias, suggesting the presence of nonreciprocal autonomic modulations.

Conclusions— Symbolic analysis of 3 beat sequences takes into account the different time course of sympathetic and parasympathetic cardiac modulations and seems appropriate for elucidating the neural pathophysiological mechanisms occurring during the short periods that precede acute cardiac events.

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