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(Circulation. 1996;93:1043-1065.)
© 1996 American Heart Association, Inc.


Articles

Heart Rate Variability

Standards of Measurement, Physiological Interpretation, and Clinical Use

Task Force of the European Society of Cardiology the North American Society of Pacing Electrophysiology

Correspondence to Marek Malik, PhD, MD, Chairman, Writing Committee of the Task Force, Department of Cardiological Sciences, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK.


Key Words: heart rate • electrocardiography • computers • nervous system, autonomic • risk factors


*    Introduction
 
The last two decades have witnessed the recognition of a significant relationship between the autonomic nervous system and cardiovascular mortality, including sudden cardiac death.1 2 3 4 Experimental evidence for an association between propensity for lethal arrhythmias and signs of either increased sympathetic or reduced vagal activity has spurred efforts for the development of quantitative markers of autonomic activity.

HRV represents one of the most promising such markers. The apparently easy derivation of this measure has popularized its use. As many commercial devices now provide an automated measurement of HRV, the cardiologist has been provided with a seemingly simple tool for both research and clinical studies.5 However, the significance and meaning of the many different measures of HRV are more complex than generally appreciated, and there is a potential for incorrect conclusions and for excessive or unfounded extrapolations.

Recognition of these problems led the European Society of Cardiology and the North American Society of Pacing and Electrophysiology to constitute a Task Force charged with the responsibility of developing appropriate standards. The specific goals of this Task Force were to (1) standardize nomenclature and develop definitions of terms, (2) specify standard methods of measurement, (3) define physiological and pathophysiological correlates, (4) describe currently appropriate clinical applications, and (5) identify areas for future research.

To achieve these goals, the members of the Task Force were drawn from the fields of mathematics, engineering, physiology, and clinical medicine. The standards and proposals offered in this text should not limit further development but should allow appropriate comparisons, promote . . . [Full Text of this Article]




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Am J Physiol Heart Circ Physiol, February 1, 2009; 296(2): H421 - H427.
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Phil Trans R Soc AHome page
L. T Mainardi
On the quantification of heart rate variability spectral parameters using time-frequency and time-varying methods
Phil Trans R Soc A, January 28, 2009; 367(1887): 255 - 275.
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Phil Trans R Soc AHome page
A. Voss, S. Schulz, R. Schroeder, M. Baumert, and P. Caminal
Methods derived from nonlinear dynamics for analysing heart rate variability
Phil Trans R Soc A, January 28, 2009; 367(1887): 277 - 296.
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J. Appl. Physiol.Home page
D. Le Gallais
Comment on Point:Counterpoint: Sickle cell trait should/should not be considered asymptomatic and as a benign condition during physical activity
J Appl Physiol, January 1, 2009; 106(1): 349 - 349.
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J Clin PharmacolHome page
J.-P. Couderc, S. Kaab, M. Hinterseer, S. McNitt, X. Xia, A. Fossa, B. M. Beckmann, S. Polonsky, and W. Zareba
Baseline Values and Sotalol-Induced Changes of Ventricular Repolarization Duration, Heterogeneity, and Instability in Patients With a History of Drug-Induced Torsades de Pointes
J. Clin. Pharmacol., January 1, 2009; 49(1): 6 - 16.
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Psychosom. Med.Home page
J. A. Grant and P. Rainville
Pain Sensitivity and Analgesic Effects of Mindful States in Zen Meditators: A Cross-Sectional Study
Psychosom Med, January 1, 2009; 71(1): 106 - 114.
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J. Physiol.Home page
A. R. Burton, I. Birznieks, P. S. Bolton, L. A. Henderson, and V. G. Macefield
Effects of deep and superficial experimentally induced acute pain on muscle sympathetic nerve activity in human subjects
J. Physiol., January 1, 2009; 587(1): 183 - 193.
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ESC Textbook of Cardiovascular MedicineHome page
F. G. Cosío, J.#x. Palacios, A.#x.;n Pastor, and A. Núñez
CHAPTER 2 The Electrocardiogram
ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter.
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Eur Heart JHome page
P. L.S. Ljungman, N. Berglind, C. Holmgren, F. Gadler, N. Edvardsson, G. Pershagen, M. Rosenqvist, B. Sjogren, and T. Bellander
Rapid effects of air pollution on ventricular arrhythmias
Eur. Heart J., December 1, 2008; 29(23): 2894 - 2901.
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Arch Gen PsychiatryHome page
C. M. M. Licht, E. J. C. de Geus, F. G. Zitman, W. J. G. Hoogendijk, R. van Dyck, and B. W. J. H. Penninx
Association Between Major Depressive Disorder and Heart Rate Variability in the Netherlands Study of Depression and Anxiety (NESDA)
Arch Gen Psychiatry, December 1, 2008; 65(12): 1358 - 1367.
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Am. J. Physiol. Regul. Integr. Comp. Physiol.Home page
A. Van de Louw, C. Medigue, Y. Papelier, and F. Cottin
Breathing cardiovascular variability and baroreflex in mechanically ventilated patients
Am J Physiol Regulatory Integrative Comp Physiol, December 1, 2008; 295(6): R1934 - R1940.
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EuropaceHome page
S. Ketels, R. Houben, K. Van Beeumen, R. Tavernier, and M. Duytschaever
Incidence, timing, and characteristics of acute changes in heart rate during ongoing circumferential pulmonary vein isolation
Europace, December 1, 2008; 10(12): 1406 - 1414.
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EuropaceHome page
M. P. Tan, J. L. Newton, T. J. Chadwick, and S. W. Parry
The relationship between carotid sinus hypersensitivity, orthostatic hypotension, and vasovagal syncope: a case-control study
Europace, December 1, 2008; 10(12): 1400 - 1405.
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Diabetes and Vascular Disease ResearchHome page
M. Schonauer, A. Thomas, S. Morbach, J. Niebauer, U. Schonauer, and H. Thiele
Cardiac autonomic diabetic neuropathy
Diabetes and Vascular Disease Research, November 1, 2008; 5(4): 336 - 344.
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J PsychopharmacolHome page
S-S. Chiou and C-D. Kuo
Effect of chewing a single betel-quid on autonomic nervous modulation in healthy young adults
J Psychopharmacol, November 1, 2008; 22(8): 910 - 917.
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Psychosom. Med.Home page
M. R. Bhattacharyya, D. L. Whitehead, R. Rakhit, and A. Steptoe
Depressed Mood, Positive Affect, and Heart Rate Variability in Patients With Suspected Coronary Artery Disease
Psychosom Med, November 1, 2008; 70(9): 1020 - 1027.
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Am. J. Physiol. Heart Circ. Physiol.Home page
A. U. Viola, L. M. James, S. N. Archer, and D.-J. Dijk
PER3 polymorphism and cardiac autonomic control: effects of sleep debt and circadian phase
Am J Physiol Heart Circ Physiol, November 1, 2008; 295(5): H2156 - H2163.
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Biol Res NursHome page
C. A. Brown, C. T. Lee, S. M. J. Hains, and B. S. Kisilevsky
Maternal Heart Rate Variability and Fetal Behavior in Hypertensive and Normotensive Pregnancies
Biol Res Nurs, October 1, 2008; 10(2): 134 - 144.
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J. Appl. Physiol.Home page
J. A. Moffitt, A. J. Grippo, T. G. Beltz, and A. K. Johnson
Hindlimb unloading elicits anhedonia and sympathovagal imbalance
J Appl Physiol, October 1, 2008; 105(4): 1049 - 1059.
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J. Appl. Physiol.Home page
L.-F. Zhang, J.-H. Cheng, X. Liu, S. Wang, Y. Liu, H.-B. Lu, and J. Ma
Cardiovascular changes of conscious rats after simulated microgravity with and without daily -Gx gravitation
J Appl Physiol, October 1, 2008; 105(4): 1134 - 1145.
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J Clin PharmacolHome page
M. Malik, K. Hnatkova, J. Ford, and D. Madge
Near-Thorough QT Study as Part of a First-In-Man Study
J. Clin. Pharmacol., October 1, 2008; 48(10): 1146 - 1157.
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J Am Coll CardiolHome page
J. J. Goldberger, M. E. Cain, S. H. Hohnloser, A. H. Kadish, B. P. Knight, M. S. Lauer, B. J. Maron, R. L. Page, R. S. Passman, D. Siscovick, et al.
American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society Scientific Statement on Noninvasive Risk Stratification Techniques for Identifying Patients at Risk for Sudden Cardiac Death: A Scientific Statement From the American Heart Association Council on Clinical Cardiology Committee on Electrocardiography and Arrhythmias and Council on Epidemiology and Prevention
J. Am. Coll. Cardiol., September 30, 2008; 52(14): 1179 - 1199.
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CirculationHome page
J. J. Goldberger, M. E. Cain, S. H. Hohnloser, A. H. Kadish, B. P. Knight, M. S. Lauer, B. J. Maron, R. L. Page, R. S. Passman, D. Siscovick, et al.
American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society Scientific Statement on Noninvasive Risk Stratification Techniques for Identifying Patients at Risk for Sudden Cardiac Death: A Scientific Statement From the American Heart Association Council on Clinical Cardiology Committee on Electrocardiography and Arrhythmias and Council on Epidemiology and Prevention
Circulation, September 30, 2008; 118(14): 1497 - 1518.
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