Patterns of beat-to-beat heart rate variability in advanced heart failure

Woo, Mary A.; Stevenson, William G.; Moser, Debra K.; Trelease, Robert B.; Harper, Ronald M.

doi:10.1016/0002-8703(92)90510-3

Cited by 358 publications

(213 citation statements)

References 16 publications

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“…Although the term "erratic rhythm" was not used, abnormal 24-hour Poincaré plots have identified higher-risk patients with CHF. Woo et al characterized Poincaré plots in patients with advance heart failure compared to normals (15). Seven of nine patients in the "complex" group died suddenly within 6 months of the recording.…”

Section: Discussionmentioning

confidence: 99%

Development of more erratic heart rate patterns is associated with mortality post–myocardial infarction

Stein

Domitrovich

2008

Journal of Electrocardiology

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Cardiac patients often have sinus arrhythmia of non-respiratory origin [erratic sinus rhythm" (ESR)]. ESR was quantified using hourly Poincaré and power spectral HRV plots from normal-to-normal interbeat intervals (N-Ns) and hourly values of the short-term fractal scaling exponent and correlations of N-Ns in N=60 non-survivors and N=66 randomly-selected survivors in the Cardiac Arrhythmia Suppression Trial. Hours were coded (ABN) as normal (0), borderline (0.5) or ESR (1). T-tests compared ABN for N=2413 paired hours at baseline and on therapy. ABN was higher in nonsurvivors (0.38 ± 0.44 vs. 0.28 ± 0.40, baseline and 0.51 ± 0.45 vs. 0.34 ± 0.43, on therapy, p<0.001). Increased ABN with treatment was greater in non-survivors. Normal hours at baseline (RR=0.77, 095% CI=0.62−0.96, p=0.018) and on treatment (RR=0.47, 95%CI=0.39−0.58) were significantly associated with decreased mortality compared to ESR. Quantification of ESR may identify more vulnerable patients or help monitor the effects of pharmacological treatment. Keywordsheart rate; risk factor; mortality; post-MI; anti-arrhythmic The analysis of heart rate variability (HRV) provides information about cardiac autonomic function. However, we have found that many older subjects and patients with cardiovascular disease have an increased beat-to-beat variability that is irregular and does not reflect underlying respiratory sinus arrhythmia (1). We have called this erratic rhythm. The presence of erratic rhythm, which is frequently episodic, increases values for short-term HRV indices such as rMSSD [root mean square of successive differences of normal-to-normal (N-N) interbeat intervals in ms], pNN50 [the % of N-N intervals >50 ms different from the previous interval) and high frequency power (the amount of variance in N-N intervals at respiratory frequencies, i.e., 0.15−0.4 Hz) that quantify beat-to-beat variability. Thus, in the presence of erratic rhythm, increased short-term HRV does not, as it does for younger people, necessarily reflect greater parasympathetic control of heart rate. A high prevalence of erratic rhythm may also explain why HRV measures that are believed to reflect parasympathetic function have relatively little predictive value for outcomes. At the same time, some "non-linear" HRV measures like the short-term fractal scaling exponent, (DFA1), and (SD12), the ratio of the axes of an ellipse fitted to the Poincaré plot do capture the presence of erratic rhythm (2,3).

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Section: Discussionmentioning

confidence: 99%

Development of more erratic heart rate patterns is associated with mortality post–myocardial infarction

Stein

Domitrovich

2008

Journal of Electrocardiology

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“…1). Poincare plot analysis is an emerging quantitativevisual technique whereby the shape of the plot is categorized into functional classes that indicate the degree of the heart failure in a subject [43]. The plot provides summary information as well as detailed beat-to-beat information on the behavior of the heart [19].…”

Section: Poincare Plot Geometrymentioning

confidence: 99%

Effect of reflexological stimulation on heart rate variability

et al. 2004

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“…The loss of HRV is reported to reflect an alteration in autonomic nervous system function (16)(17)(18). A number of disease states are associated with changes in HRV, including heart failure (19,20), sudden infant death syndrome (21), myocardial infarction (22,23), prematurity (24), neonatal respiratory distress syndrome (25)(26)(27)(28), and diabetes (29). We hypothesize that CCHS patients will exhibit changes in HRV and that these changes have the potential to provide insights into the nature of autonomic control in CCHS.…”

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confidence: 99%

Heart Rate Variability in Congenital Central Hypoventilation Syndrome

Woo²,

et al. 1992

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ABSTRACT. Heart rate variability was assessed in 12 patients with congenital central hypoventilation syndrome (CCHS) and in age-and sex-matched controls using SD of time intervals between R waves (R-R intervals), R-R interval histograms, spectral analysis, and PoincarC plots of sequential R-R intervals over a 24-h period using ambulatory monitoring. Mean heart rates in patients with CCHS were 103.3 f 17.7 SD and in controls were 98.8 f 21.6 SD ( p > 0.5, NS). SD analysis of R-R intervals showed similar results in both groups (CCHS 102.2 f 36.0 ms versus controls 126.1 f 43.3 ms; p > 0.1, NS). Spectral analysis revealed that, for similar epochs sampled during quiet sleep and wakefulness, the ratios of low-frequency band to high-frequency band spectral power were increased for 11 of 12 patients with CCHS during sleep, whereas a decrease in these ratios was consistently observed in all controls during comparable sleep states (xZ = 20.31; p < 0.000007). During wakefulness, the ratios of low-frequency band to high-frequency band spectral power were similar in both patients with CCHS and controls. Poincare plots displayed significantly reduced beat-to-beat changes at slower heart rates in the CCHS patients (xZ = 24.0; p < 0.000001). The scatter of points in CCHS Poincare plots was easily distinguished from controls. All CCHS patients showed disturbed variability with one or more measures. The changes in moment-to-moment heart rate variability suggest that, in addition to a loss of ventilatory control, CCHS patients exhibit a dysfunction in autonomic nervous system control of the heart. (Pediafr Res 31: 291-296, 1992) Abbreviations CCHS, congenital central hypoventilation syndrome HRV, heart rate variability R-R, time interval between R waves LO-HI, ratio of low-frequency band to high-frequency band spectral power

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Patterns of beat-to-beat heart rate variability in advanced heart failure

Cited by 358 publications

References 16 publications

Development of more erratic heart rate patterns is associated with mortality post–myocardial infarction

Development of more erratic heart rate patterns is associated with mortality post–myocardial infarction

Effect of reflexological stimulation on heart rate variability

Heart Rate Variability in Congenital Central Hypoventilation Syndrome

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