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Heart rate variability [PMIDT24095141]
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
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