Assessing cardiac autonomic function via heart rate variability analysis requires monitoring respiration

Pathological Heart Rate Regulation in Apparently Healthy Individuals

Cardiovascular diseases are the leading cause of morbidity and mortality in adults worldwide. There is one common pathophysiological aspect present in all cardiovascular diseases-dysfunctional heart rhythm regulation. Taking this aspect into consideration for cardiovascular risk predictions opens important research perspectives, allowing for the development of preventive treatment techniques. The aim of this study was to find out whether certain pathologically appearing signs in the heart rate variability (HRV) of an apparently healthy person, even with high HRV, can be defined as biomarkers for a disturbed cardiac regulation and whether this can be treated preventively by a drug-free method. This multi-phase study included 218 healthy subjects of either sex, who consecutively visited the physician at Gesundheit clinic because of arterial hypertension, depression, headache, psycho-emotional stress, extreme weakness, disturbed night sleep, heart palpitations, or chest pain. In study phase A, baseline measurement to identify individuals with cardiovascular risks was done. Therefore, standard HRV, as well as the new cardiorhythmogram (CRG) method, were applied to all subjects. The new CRG analysis used here is based on the recently introduced LF drops and HF counter-regulation. Regarding the mechanisms of why these appear in a steady-state cardiorhythmmogram, they represent non-linear event-based dynamical HRV biomarkers. The next phase of the study, phase B, tested whether the pathologically appearing signs identified via CRG in phase A could be clinically influenced by drug-free treatment. In order to validate the new CRG method, it was supported by non-linear HRV analysis in both phase A and in phase B. Out of 218 subjects, the pathologically appearing signs could be detected in 130 cases (60%), p < 0.01, by the new CRG method, and by the standard HRV analysis in 40 cases (18%), p < 0.05. Thus, the CRG method was able to detect 42% more cases with pathologically appearing cardiac regulation. In addition, the comparative CRG analysis before and after treatment showed that the pathologically appearing signs could be clinically influenced without the use of medication. After treatment, the risk group decreased eight-fold-from 130 people to 16 (p < 0.01). Therefore, progression of the detected pathological signs to structural cardiac pathology or arrhythmia could be prevented in most of the cases. However, in the remaining risk group of 16 apparently healthy subjects, 8 people died due to all-cause mortality. In contrast, no other subject in this study has died so far. The non-linear parameter which is able to quantify the changes in CRGs before versus after treatment is FWRENYI4 (symbolic dynamic feature); it decreased from 2.85 to 2.53 (p < 0.001). In summary, signs of pathological cardiac regulation can be identified by the CRG analysis of apparently healthy subjects in the early stages of development of cardiac pathology. Thus, our method offers a sensitive biomarker for cardiovascular risks. The latter can be influenced by non-drug treatments (acupuncture) to stop the progression into structural cardiac pathologies or arrhythmias in most but not all of the patients. Therefore, this could be a real and easy-to-use supplemental method, contributing to primary prevention in cardiology.

Cardiac Autonomic Dysfunction and Incidence of de novo Atrial Fibrillation: Heart Rate Variability vs. Heart Rate Complexity

BACKGROUND

The REACT DX registry evaluates standard therapies to episodes of long-lasting atrial tachyarrhythmias and assesses the quality of sensing and stability of the lead and the implantable cardioverter-defibrillator (ICD) (BIOTRONIK Lumax VR-T DX and successors) over at least a 1-year follow-up period.

OBJECTIVE

To study the association between the risk of de novo device-detected atrial fibrillation (AF), the autonomic perturbations before the onset of paroxysmal AF and a 7-days heart rate variability (7dHRV) 1 month after ICD implantation.

METHODS

The registry consists of 234 patients implanted with an ICD, including 10 with de novo long-lasting atrial tachyarrhythmias with no prior history of AF. The patients were matched via the propensity-score methodology as well as for properties directly influencing the ECGs recorded using GE CardioMem CM 3000. Heart rate variability (HRV) analysis was performed using standard parameters from time- and frequency-domains, and from non-linear dynamics.

RESULTS

No linear HRV was associated with an increased risk of AF (p = n.s.). The only significant approach was derived from symbolic dynamics with the parameter "forbidden words" which distinguished both groups on all 7 days of measurements (p < 0.05), thereby quantifying the heart rate complexity (HRC) as drastically lower in the de novo AF group.

CONCLUSION

Cardiac autonomic dysfunction denoted by low HRC may be associated with higher AF incidence. For patients with mild to moderate heart failure, standard HRV parameters are not appropriate to quantify cardiac autonomic perturbations before the onset of AF. Further studies are needed to determine the individual risk for AF that would enable interventions to restore autonomic balance in the general population.

Minimal Window Duration for Accurate HRV Recording in Athletes

Heart rate variability (HRV) is non-invasive and commonly used for monitoring responses to training loads, fitness, or overreaching in athletes. Yet, the recording duration for a series of RR-intervals varies from 1 to 15 min in the literature. The aim of the present work was to assess the minimum record duration to obtain reliable HRV results. RR-intervals from 159 orthostatic tests (7 min supine, SU, followed by 6 min standing, ST) were analyzed. Reference windows were 4 min in SU (min 3-7) and 4 min in ST (min 9-13). Those windows were subsequently divided and the analyses were repeated on eight different fractioned windows: the first min (0-1), the second min (1-2), the third min (2-3), the fourth min (3-4), the first 2 min (0-2), the last 2 min (2-4), the first 3 min (0-3), and the last 3 min (1-4). Correlation and Bland & Altman statistical analyses were systematically performed. The analysis window could be shortened to 0-2 instead of 0-4 for RMSSD only, whereas the 4-min window was necessary for LF and total power. Since there is a need for 1 min of baseline to obtain a steady signal prior the analysis window, we conclude that studies relying on RMSSD may shorten the windows to 3 min (= 1+2) in SU or seated position only and to 6 min (= 1+2 min SU plus 1+2 min ST) if there is an orthostatic test. Studies relying on time- and frequency-domain parameters need a minimum of 5 min (= 1+4) min SU or seated position only but require 10 min (= 1+4 min SU plus 1+4 min ST) for the orthostatic test.

Recovery of heart rate variability after treadmill exercise analyzed by lagged Poincaré plot and spectral characteristics

The aim of this study was to analyze the recovery of heart rate variability (HRV) after treadmill exercise and to investigate the autonomic nervous system response after exercise. Frequency domain indices, i.e., LF(ms²), HF(ms²), LF(n.u.), HF(n.u.) and LF/HF, and lagged Poincaré plot width (SD1 _m ) and length (SD2 _m ) were introduced for comparison between the baseline period (Pre-E) before treadmill running and two periods after treadmill running (Post-E1 and Post-E2). The correlations between lagged Poincaré plot indices and frequency domain indices were applied to reveal the long-range correlation between linear and nonlinear indices during the recovery of HRV. The results suggested entirely attenuated autonomic nervous activity to the heart following the treadmill exercise. After the treadmill running, the sympathetic nerves achieved dominance and the parasympathetic activity was suppressed, which lasted for more than 4 min. The correlation coefficients between lagged Poincaré plot indices and spectral power indices could separate not only Pre-E and two sessions after the treadmill running, but also the two sessions in recovery periods, i.e., Post-E1 and Post-E2. Lagged Poincaré plot as an innovative nonlinear method showed a better performance over linear frequency domain analysis and conventional nonlinear Poincaré plot.