Advances in heart rate variability signal analysis: joint position statement by the e-Cardiology ESC Working Group and the European Heart Rhythm Association co-endorsed by the Asia Pacific Heart Rhythm Society

Abstract

Following the publication of the Task Force document on heart rate variability (HRV) in 1996, a number of articles have been published to describe new HRV methodologies and their application in different physiological and clinical studies. This document presents a critical review of the new methods. A particular attention has been paid to methodologies that have not been reported in the 1996 standardization document but have been more recently tested in sufficiently sized populations. The following methods were considered: Long-range correlation and fractal analysis; Short-term complexity; Entropy and regularity; and Nonlinear dynamical systems and chaotic behaviour. For each of these methods, technical aspects, clinical achievements, and suggestions for clinical application were reviewed. While the novel approaches have contributed in the technical understanding of the signal character of HRV, their success in developing new clinical tools, such as those for the identification of high-risk patients, has been rather limited. Available results obtained in selected populations of patients by specialized laboratories are nevertheless of interest but new prospective studies are needed. The investigation of new parameters, descriptive of the complex regulation mechanisms of heart rate, has to be encouraged because not all information in the HRV signal is captured by traditional methods. The new technologies thus could provide after proper validation, additional physiological, and clinical meaning. Multidisciplinary dialogue and specialized courses in the combination of clinical cardiology and complex signal processing methods seem warranted for further advances in studies of cardiac oscillations and in the understanding normal and abnormal cardiac control processes.

Heart rate variability in insomnia patients: A critical review of the literature

“…(5, 9, 13) Accordingly, the research focus has shifted to investigating the associations between HRV, sleep disorders and their subsequent comorbidities and the incorporation of non-traditional HRV techniques. (5,13,14) Given the interplay between HRV and cardiac autonomic activity, the use of HRV in insomnia research may assist further investigation into the pathophysiology and potential health impacts of insomnia. Hyperarousal has been defined as 'a state of increased arousal at the physiological, cortical, cognitive or emotional level' (15) and hypothesised to contribute to the development, maintenance and 24-hour systemic sequelae of insomnia.…”

High‐frequency autonomic modulation: a new model for analysis of autonomic cardiac control

“…Since the publication of the HRV Task Force reference document, numerous publications on HRV have appeared and new methods of time and frequency domain analysis have been proposed. However, their contribution to the development of new clinical tools for the detection of high‐risk patients is considered rather limited (Sassi et al ., 2015). …”

Informative Nature and Nonlinearity of Lagged Poincaré Plots Indices in Analysis of Heart Rate Variability

“…Certain publications deal with diagnosis and classification of arrhythmias based on nonlinear parameters [23,24], even up to the point of prognosis of various cardiovascular diseases like ventricular tachycardia and congestive heart failure [25]. With that, the additional clinical validation of existing novel methods is needed to define the clinical predictive value of nonlinear parameters as well as their robustness in relation to reproducibility and widespread clinical use [26].…”