The full content of Annals is available to subscribers

Subscribe/Learn More  >
Reviews |

Heart Rate Variability

Conny M. A. van Ravenswaaij-Arts, MD; Louis A. A. Kollee, MD, PhD; Jeroen C. W. Hopman, MSc; Gerard B. A. Stoelinga, MD, PhD; and Herman P. van Geijn, MD, PhD
[+] Article, Author, and Disclosure Information

From University Hospital, Nijmegen, and Free University Hospital, Amsterdam, The Netherlands. Requests for Reprints: C. M. A. van Ravenswaaij-Arts, MD, Department of Pediatrics, University Hospital, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. Acknowledgment: The authors thank Dr. W. Aengevaeren for his review of the manuscript.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1993;118(6):436-447. doi:10.7326/0003-4819-118-6-199303150-00008
Text Size: A A A

Purpose: To present an overview of the applicability of heart rate variability measurements in medicine.

Data Sources: During a 4-year period all new papers concerning heart rate variability were collected. A selection of the most recent publications in the presented research area was used for this review.

Data Synthesis: The amount of short- and long-term variability in heart rate reflects the vagal and sympathetic function of the autonomic nervous system, respectively. Therefore heart rate variability can be used as a monitoring tool in clinical conditions with altered autonomic nervous system function. In postinfarction and diabetic patients, low heart rate variability is associated with an increased risk for sudden cardiac death. A sympathovagal imbalance is also detectable with heart rate variability analysis in coronary artery disease and essential hypertension. Besides diabetic neuropathy, in many other neurologic disorders, such as brain damage, the Guillain-Barre syndrome, and uremic neuropathy, heart rate variability analysis can provide insight into which division of the autonomic nervous system is most affected. Heart rate variability can be influenced by various groups of drugs, but it can also shed light on the mode of action of drugs. The protective effect of cardiovascular drugs in postinfarction patients has been investigated.

Conclusions: Heart rate variability analysis is easily applicable in adult medicine, but physiologic influences such as age must be considered. The most important application is the surveillance of postinfarction and diabetic patients to prevent sudden cardiac death. With heart rate variability analysis, individual therapy adjustments to achieve the most favorable sympathetic-parasympathetic balance might be possible in the future.


Grahic Jump Location
Figure 1.
Scheme of the cardiovascular control mechanisms responsible for the main periodic fluctuations in heart rate.

The exact pathways through the brainstem are not visualized.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Example of an adult heart rate trace.Top.Bottom.

Each point represents the instantaneous heart rate calculated from the accessory R-R interval length. Beat-to-beat or short-term variability (STV) and long-term variability (LTV) are indicated. Heart rate power spectrum of the heart rate trace visualized in the top panel. The three main components (peaks) of the power spectrum correspond to the main periodic fluctuations in heart rate: thermoregulation-related heart rate variability: very-low-frequency (VLF) fluctuations, fewer than 3 per minute or 0.05 Hz; baroreflex-related heart rate variability: low-frequency (LF) fluctuations, approximately 6 per minute or 0.1 Hz; and respiratory sinus arrhythmia: high-frequency (HF) fluctuations, equal to the respiratory rate, for example, 19/min or 0.32 Hz. The area under each peak corresponds to the amount or amplitude of each specific fluctuation present in the original heart rate trace.

Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Journal Club
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.