Heart Rate Variability
Standards of Measurement, Physiological Interpretation, and Clinical Use
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 circumspect interpretations, and lead to further progress in the field.
The phenomenon that is the focus of this report is the oscillation in the interval between consecutive heartbeats as well as the oscillations between consecutive instantaneous heart rates. “Heart rate variability” has become the conventionally …