Heart rate variability [PMIDT24095141].pdfVIP

Handbook of Clinical Neurology, Vol. 117 (3rd series) Autonomic Nervous System R.M. Buijs and D.F. Swaab, Editors ? 2013 Elsevier B.V. All rights reservedChapter 31 Heart rate variabilityIWONA CYGANKIEWICZ1* AND WOJCIECH ZAREBA2 1Department of Electrocardiology, Medical University of Lodz, Lodz, Poland 2Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY, USAINTRODUCTION Heart rate variability (HRV) reflects beat-to-beat changes in RR intervals, which are related to the ongoing interplay between two arms of the autonomic nervous system (Task Force, 1996; Kleiger et al., 2005; Bilchick and Berger, 2006; Lahiri et al., 2008). Sinus node, the major heart’s pacemaker, presents its own intrinsic activ- ity; nevertheless, a variety of internal and external stimuli that change the balance between sympathetic and vagal tone influence the final basic heart rate. Heart rate changes may occur as a response to mental or physical stress, cardiac or noncardiac diseases, or pharmacologi- cal or invasive treatment. Autonomic nervous system imbalance, with a shift toward increased sympathetic and decreased vagal tone, has been proven to be associ- ated with higher risk of cardiac mortality. Therefore HRV has become an important and well-recognized tool in identifying patients at risk of cardiovascular death (Task Force, 1996; Perkiomaki et al., 2000; Lombardi, 2001; Malik, 2004; Kleiger et al., 2005; Bilchick and Berger, 2006; Lahiri et al., 2008). Not surprisingly, taking into consideration strict heart–brain relationships, HRV assessment has become an important diagnostic tool in the detection of autonomic impairment and prediction of prognosis in several neurological disorders.HEART RATEVARIABILITY MEASUREMENT Heart rate variabilitymeasurementmay be based on a bat- tery of simple bedside reflex tests ormay implementmore advanced computer-based algorithms to reflect RR inter- val changes. Electrocardiogram (ECG)-based evaluation of HRVmay be per