Heart-rate-variability_a-noninvasive-electrocardiographic-_2004.pdfVIP

Heart rate variability: a noninvasive electrocardiographic method to measure the autonomic nervous system Juan Sztajzel Cardiology Center and Medical Policlinics, University Hospital, Geneva, Switzerland The autonomic nervous system (ANS) plays an important role not only in physiological situa- tions, but also in various pathological settings such as diabetic neuropathy, myocardial infarction (MI) and congestive heart failure (CHF). Autonomic imbalance associating increased sympathetic activ- ity and reduced vagal tone has been been strongly implicated in the pathophysiology of arrhythmo- genesis and sudden cardiac death. Among the different available noninvasive techniques for assessing the autonomic status heart rate variability (HRV) has emerged as a simple, noninvasive method to evaluate the sympatho- vagal balance at the sinoatrial level. It has been used in a variety of clinical situations including diabetic neuropathy, MI, sudden death and CHF. The standard measurements intervening in the analysis of HRV comprise time domain indices, geometric methods and components of the fre- quency domain. Measurements of HRV are gen- erally performed on the basis of 24 hour Holter recordings (long-term recordings) or on shorter periods ranging from 0.5 to 5 minutes (short-term recordings). The use of long or short-term record- ings depends on the type of study that has to be realised. Established clinical data based on numerous studies published during the last decade consider decreased global HRV as a strong predictor of in- creased all-cause cardiac and/or arrhythmic mor- tality, particularly in patients at risk after MI or with CHF. This article reviews the mechanism, the pa- rameters and the use of HRV as a marker reflect- ing the activity of the sympathetic and vagal com- ponents of the ANS on the sinus node, and as a clinical tool for screening and identifying patients particularly at risk for cardiac mortality. Key words: autonomic nervous system; arrhythmo-