Heart rate variability: Standards of measurement, physiological interpretation, and clinical use

Circulation

Volumn 93, Issue 5, 1996, Pages 1043-1065

  Malik, Marek ^a   John Camm, A ^a   Thomas Bigger, J ^b,c   Breithardt, Günter ^b,c   Cerutti, Sergio ^b   Cohen, Richard J ^b   Coumel, Philippe ^b   Fallen, Ernest L ^b   Kennedy, Harold L ^b   Kleiger, Robert E ^b   Lombardi, Federico ^b   Malliani, Alberto ^b   Moss, Arthur J ^b   Rottman, Jeffrey N ^b   Schmidt, Georg ^b   Schwartz, Peter J ^b   Singer, Donald H ^b  

^a London   (United Kingdom)

^b NONE   (United States)

^c NONE   (Germany)

Author keywords

computers; electrocardiography; heart rate; nervous system, autonomic; risk factors

Indexed keywords

AMIODARONE; ANALGESIC AGENT; ANESTHETIC AGENT; ANTIARRHYTHMIC AGENT; ANTINEOPLASTIC AGENT; ANXIOLYTIC AGENT; ATROPINE; BETA ADRENERGIC RECEPTOR BLOCKING AGENT; CALCIUM CHANNEL BLOCKING AGENT; DOXORUBICIN; ENCAINIDE; FLECAINIDE; MORACIZINE; MUSCARINIC RECEPTOR BLOCKING AGENT; NARCOTIC AGENT; PROPAFENONE; SCOPOLAMINE; SEDATIVE AGENT; VINCRISTINE;

ACUTE HEART INFARCTION; ARTICLE; AUTONOMIC NERVOUS SYSTEM FUNCTION; CARDIOVASCULAR DISEASE; CARDIOVASCULAR RESPONSE; DIABETIC NEUROPATHY; DRUG MECHANISM; ELECTROCARDIOGRAM; HEART ARRHYTHMIA; HEART ELECTROPHYSIOLOGY; HEART RATE; HEART TRANSPLANTATION; PRIORITY JOURNAL; QUADRIPLEGIA; RISK ASSESSMENT; SUDDEN DEATH; TREATMENT OUTCOME;

EID: 0029928495     PISSN: 00097322     EISSN: None     Source Type: Journal    
DOI: 10.1161/01.cir.93.5.1043     Document Type: Article

References (181)

1. Lown B, Verrier RL. Neural activity and ventricular fibrillation. N Engl J Med. 1976;294:1165-1170.
2. Corr PB, Yamada KA, Witkowski FX. Mechanisms controlling cardiac autonomic function and their relation to arrhythmogenesis. In: Fozzard HA, Haber E, Jennings RB, Katz AN, Morgan HE, eds. The Heart and Cardiovascular System. New York, NY: Raven Press; 1986:1343-1403.
3. Schwartz PJ, Priori SG. Sympathetic nervous system and cardiac arrhythmias. In: Zipes DP, Jalife J, eds. Cardiac Electrophysiology: From Cell to Bedside. Philadelphia, Pa: WB Saunders Co; 1990: 330-343.
4. Levy MN, Schwartz PJ, eds. Vagal Control of the Heart: Experimental Basis and Clinical Implications. Armonk, NY: Futura; 1994.
5. Dreifus LS, Agarwal JB, Botvinick EH, Ferdinand KC, Fisch C, Fisher JD, Kennedy JW, Kerber RE, Lambert CR, Okike ON, Prystowsky EN, Saksena SV, Schroeder JS, Williams DO (American College of Cardiology Cardiovascular Technology Assessment Committee). Heart rate variability for risk stratification of life-threatening arrhythmias. J Am Coll Cardiol. 1993;22: 948-950.
6. Hon EH, Lee ST. Electronic evaluations of the fetal heart rate patterns preceding fetal death: further observations. Am J Obstet Gynecol. 1965;87:814-826.
7. Sayers BM. Analysis of heart rate variability. Ergonomics. 1973;16: 17-32.
8. Penaz J, Roukenz J, Van der Waal HJ. In: Drischel H, Tiedt N, eds. Spectral Analysis of Some Spontaneous Rhythms in the Circulation. Leipzig, Germany: Biokybernetik, Karl Marx University; 1968:233-241.
9. Luczak H, Lauring WJ. An analysis of heart rate variability. Ergonomics. 1973;16:85-97.
10. Hirsh JA, Bishop B. Respiratory sinus arrhythmia in humans: how breathing pattern modulates heart rate. Am J Physiol. 1981;241: H620-H629.
11. Ewing DJ, Martin CN, Young RJ, Clarke BF. The value of cardiovascular autonomic function tests: 10 years' experience in diabetes. Diabetes Care. 1985;8:491-498.
12. Wolf MM, Varigos GA, Hunt D, Sloman JG. Sinus arrhythmia in acute myocardial infarction. Med J Aust. 1978;2:52-53.
13. Akselrod S, Gordon D, Ubel FA, Shannon DC, Barger AC, Cohen RJ. Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat to beat cardiovascular control. Science. 1981; 213:220-222.
14. Pomeranz M, Macaulay RJB, Caudill MA, Kutz I, Adam D, Gordon D, Kilborn KM, Barger AC, Shannon DC, Cohen RJ, Benson M. Assessment of autonomic function in humans by heart rate spectral analysis. Am J Physiol. 1985;248:H151-H153.
15. Pagani M, Lombardi F, Guzzetti S, Rimoldi O, Furlan R, Pizzinelli P, Sandrone G, Malfatto G, Dell'Orto S, Piccaluga E, Turiel M, Baselli G, Cerutti S, Malliani A. Power spectral analysis of heart rate and arterial pressure variabilities as a marker of sympathovagal interaction in man and conscious dog. Circ Res. 1986;59:178-193.
16. Kleiger RE, Miller JP, Bigger JT, Moss AJ, and the Multicenter Post-Infarction Research Group. Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol. 1987;59:256-262.
17. Malik M, Farrell T, Cripps T, Camm AJ. Heart rate variability in relation to prognosis after myocardial infarction: selection of optimal processing techniques. Eur Heart J. 1989;10:1060-1074.
18. Bigger JT, Fleiss JL, Steinman RC, Rolnitzky LM, Kleiger RE, Rottman JN. Frequency domain measures of heart period variability and mortality after myocardial infarction. Circulation. 1992; 85:164-171.
19. Saul JP, Albrecht P, Berger RD, Cohen RJ. Analysis of long-term heart rate variability: methods, 1/f scaling and implications. In: Computers in Cardiology 1987. Washington, DC: IEEE Computer Society Press; 1988:419-422.
20. Bjökander I, Held C, Forslund L, Erikson S, Billing E, Hjemdahl P, Rehnqvist N. Heart rate variability in patients with stable angina pectoris. Eur Heart J. 1992;13:379. Abstract.
21. Scherer P, Ohler JP, Hirche H, Höpp H-W. Definition of a new beat-to-beat parameter of heart rate variability. PACE Pacing Clin Electrophysiol. 1993;16:939. Abstract.
22. Malik M, Xia R, Odemuyiwa O, Staunton A, Poloniecki J, Camm AJ. Influence of the recognition artefact in the automatic analysis of long-term electrocardiograms on time-domain measurement of heart rate variability, Med Biol Eng Comput. 1993;31:539-544.
23. Kay SM, Marple SL. Spectrum analysis: a modern perspective. Proc IEEE. 1981;69:1380-1419.
24. Malliani A, Pagani M, Lombardi F, Cerutti S. Cardiovascular neural regulation explored in the frequency domain. Circulation. 1991;84:1482-1492.
25. Furlan R, Guzetti S, Crivellaro W, Dassi S, Tinelli M, Baselli G, Cerutti S, Lombardi F, Pagani M, Malliani A. Continuous 24-hour assessment of the neural regulation of systemic arterial pressure and RR variabilities in ambulant subjects. Circulation. 1990;81: 537-547.
26. Berger RD, Akselrod S, Gordon D, Cohen RJ. An efficient algorithm for spectral analysis of heart rate variability. IEEE Trans Biomed Eng. 1986;33:900-904.
27. Rottman JN, Steinman RC, Albrecht P, Bigger JT, Rolnitzky LM, Fleiss JL. Efficient estimation of the heart period power spectrum suitable for physiologic or pharmacologic studies. Am J Cardiol. 1990;66:1522-1524.
28. Malik M, Camm AJ. Components of heart rate variability: what they really mean and what we really measure. Am J Cardiol. 1993; 72:821-822.
29. Bendat JS, Piersol AG. Measurement and Analysis of Random Data. New York, NY: Wiley & Sons; 1966.
30. Pinna GD, Maestri R, Di Cesare A, Colombo R, Minuco G. The accuracy of power-spectrum analysis of heart-rate variability from annotated RR list generated by Holter systems. Physiol Meas. 1994;15:163-179.
31. Merri M, Farden DC, Mottley JG, Titlebaum EL. Sampling frequency of the electrocardiogram for the spectral analysis of heart rate variability. IEEE Trans Biomed Eng. 1990;37:99-106.
32. Bianchi AM, Mainardi LT, Petrucci E, Signorini MG, Mainardi M, Cerutti S. Time-variant power spectrum analysis for the detection of transient episodes in HRV signal. IEEE Trans Biomed Eng. 1993;40:136-144.
33. Friesen GM, Jannett TC, Jadalloh MA, Yates SL, Quint SR, Nogle HT. A comparison of the noise sensitivity of nine QRS detection algorithms. IEEE Trans Biomed Eng. 1990;37:85-98.
34. Kamath MV, Fallen EL. Correction of the heart rate variability signal for ectopics and missing beats. In: Malik M, Camm AJ, eds. Heart Rate Variability. Armonk, NY: Futura; 1995:75-85.
35. De Boer RW, Karemaker JM, Strackee J. Comparing spectra of a series of point events, particularly for heart-rate variability spectra. IEEE Trans Biomed Eng. 1984;31:384-387.
36. Harris FJ. On the use of windows for harmonic analysis with the discrete Fourier transform. IEEE Proc. 1978;66:51-83.
37. Box GEP, Jenkins GM. Time Series Analysis: Forecasting and Control. San Francisco, Calif: Holden Day; 1976.
38. Akaike H. A new look at the statistical model identification. IEEE Trans Autom Cont. 1974;19:716-723.
39. Kaplan DT. The analysis of variability. J Cardiovasc Electrophvsiol. 1994;5:16-19.
40. Katona PG, Jih F. Respiratory sinus arrhythmia: a noninvasive measure of parasympathetic cardiac control. J Appl Physiol. 1975; 39:801-805.
41. Eckberg DL. Human sinus arrhythmia as an index of vagal cardiac outflow. J Appl Physiol. 1983;54:961-966.
42. Fouad FM, Tarazi RC, Ferrario CM, Fighaly S, Alicandri C. Assessment of parasympathetic control of heart rate by a noninvasive method. Am J Physiol. 1984;15:H838-H842.
43. Schechtman VL, Kluge KA, Harper RM. Time-domain system for assessing variation in heart rate. Med Biol Eng Comput. 1988;26: 367-373.
44. Coumel PH, Hermida JS, Wennerblöm B, Leenhardt A, Maison-Blanche P, Cauchemez B. Heart rate variability in myocardial hypertrophy and heart failure, and the effects of beta-blocking therapy: a non-spectral analysis of heart rate oscillations. Eur Heart J. 1991;12:412-422.
45. Grossman P, Van Beek J, Wientjes C. A comparison of three quantification methods for estimation of respiratory sinus arrhythmia. Psychophysiology. 1990;27:702-714.
46. Shin SJ, Tapp WN, Reisman SS, Natelson BH. Assessment of autonomic regulation of heart rate variability by the method of complex demodulation. IEEE Traits Biomed Eng. 1989;36:274-283.
47. Kobayashi M, Musha T. 1/f fluctuation of heart beat period. IEEE Trans Biomed Eng. 1982;29:456-457.
48. Yamamoto Y, Hughson RL. Coarse-graining spectral analysis: new method for studying heart rate variability. J Appl Physiol. 1991;71:1143-1150.
49. Babloyantz A, Destexhe A. Is the normal heart a periodic oscillator? Biol Cybern. 1988;58:203-211.
50. Morfill GE, Demmel V, Schmidt G. Der plötzliche Herztod: Neue Erkenntnisse durch die Anwendung komplexer Diagnoseverfahren. Bioscope. 1994;2:11-19.
51. Schmidt G, Monfill GE. Nonlinear methods for heart rate variability assessment. In: Malik M, Camm AJ, eds. Heart Rate Variability. Armonk, NY: Futura; 1995:87-98.
52. Kleiger RE, Bigger JT, Bosner MS, Chung MK, Cook JR, Rolnitzky LM, Steinman R, Fleiss JL. Stability over time of variables measuring heart rate variability in normal subjects. Am J Cardiol. 1991;68:626-630.
53. Van Hoogenhuyze DK, Weinstein N, Martin GJ, Weiss JS, Schaad JW, Sahyouni XN, Fintel D, Remme WJ, Singer DH. Reproducibility and relation to mean heart rate of heart rate variability in normal subjects and in patients with congestive heart failure secondary to coronary artery disease. Am J Cardiol. 1991;68: 1668-1676.
54. Kautzner J. Reproducibility of heart rate variability measurement. In: Malik M, Camm AJ, eds. Heart Rate Variability. Armonk, NY: Futura; 1995:165-171.
55. Bigger JT, Fleiss JL, Rolnitzsky LM, Steinman RC. Stability over time of heart period variability in patients with previous myocardial infarction and ventricular arrhythmias. Am J Cardiol. 1992; 69:718-723.
56. Bailey JJ, Berson AS, Garson A Jr, Horan LG, Macfarlane PW, Mortara DW, Zywietz C. Recommendations for standardization and specifications in automated electrocardiography. Circulation. 1990;81:730-739.
57. Kennedy HN. Ambulatory (Holter) electrocardiography technology. Clin Cardiol. 1992;10:341-356.
58. Malik M, Cripps T, Farrell T, Camm AJ. Prognostic value of heart rate variability after myocardial infarction: a comparison of different data processing methods. Med Biol Eng Comput. 1989;27: 603-611.
59. Jalife J, Michaels DC. Neural control of sinoatrial pacemaker activity. In: Levy MN, Schwartz PJ, eds. Vagal Control of the Heart: Experimental Basis and Clinical Implications. Armonk, NY: Future; 1994:173-205.
60. Noma A, Trautwein W. Relaxation of the ACh-induced potassium current in the rabbit sinoatrial node cell. Pflugers Arch. 1978;377: 193-200.
61. Osterrieder W, Noma A, Trautwein W. On the kinetics of the potassium channel activated by acetylcholine in the S-A node of the rabbit heart. Pflugers Arch. 1980;386:101-109.
62. + channels in isolated pacemaker cells of the mammalian heart. Nature. 1983;303:250-253.
63. DiFrancesco D, Tromba C. Inhibition of the hyperpolarizing-activated current If, induced by acetylcholine in rabbit sino-atrial node myocytes. J Physiol (Lond). 1988;405:477-491.
64. DiFrancesco D, Tromba C. Muscarinic control of the hyperpolarizing activated current If in rabbit sino-atrial node myocytes. J Physiol (Lond). 1988;405:493-510.
65. Irisawa H, Brown HF, Giles WR. Cardiac pacemaking in the sinoatrial node. Physiol Rev. 1993;73:197-227.
66. Irisawa H, Giles WR. Sinus and atrioventricular node cells: cellular electrophysiology. In: Zipes DP, Jalife J, eds. Cardiac Electrophysiology: From Cell to Bedside. Philadelphia, Pa: WB Saunders Co; 1990:95-102.
67. DiFrancesco D. The contribution of the pacemaker current (If) to generation of spontaneous activity in rabbit sino-atrial node myocytes. J Physiol (Lond). 1991;434:23-40.
68. Trautwein W, Kameyama M. Intracellular control of calcium and potassium currents in cardiac cells. Jpn Heart J. 1986;27:31-50.
69. Brown HF, DiFrancesco D, Noble SJ. How does adrenaline accelerate the heart? Nature. 1979;280:235-236.
70. DiFrancesco D, Ferroni A, Mazzanti M, Tromba C. Properties of the hyperpolarizing-activated current (If) in cells isolated from the rabbit sino-atrial node. J Physiol (Lond). 1986;377:61-88.
71. Levy MN. Sympathetic-parasympathetic interactions in the heart. Circ Res. 1971;29:437-445.
72. Chess GF, Tam RMK, Calaresu FR. Influence of cardiac neural inputs on rhythmic variations of heart period in the cat. Am J Physiol. 1975;228:775-780.
73. Akselrod S, Gordon D, Madwed JB, Snidman NC, Shannon DC, Cohen RJ. Hemodynamic regulation: investigation by spectral analysis. Am J Physiol. 1985;249:H867-H875.
74. Saul JP, Rea RF, Eckberg DL, Berger RD, Cohen RJ. Heart rate and muscle sympathetic nerve variability during reflex changes of autonomic activity. Am J Physiol. 1990;258:H713-H721.
75. Schwartz PJ, Pagani M, Lombardi F, Malliani A, Brown AM. A cardiocardiac sympathovagal reflex in the cat. Circ Res. 1973;32: 215-220.
76. Malliani A. Cardiovascular sympathetic afferent fibers. Rev Physiol Biochem Pharmacol. 1982;94:11-74.
77. Cerati D, Schwartz PJ. Single cardiac vagal fiber activity, acute myocardial ischemia, and risk for sudden death. Circ Res. 1991;69: 1389-1401.
78. Kamath MV, Fallen EL. Power spectral analysis of heart rate variability: a noninvasive signature of cardiac autonomic function. Crit Rev Biomed Eng. 1993;21:245-311.
79. Rimoldi O, Pierini S, Ferrari A, Cerutti S, Pagani M, Malliani A. Analysis of short-term oscillations of R-R and arterial pressure in conscious dogs. Am J Physiol. 1990;258:H967-H976.
80. Montano N, Ruscone TG, Porta A, Lombardi F, Pagani M, Malliani A. Power spectrum analysis of heart rate variability to assess the changes in sympathovagal balance during graded orthostatic tilt. Circulation. 1994;90:1826-1831.
81. Appel ML, Berger RD, Saul JP, Smith JM, Cohen RJ. Beat to beat variability in cardiovascular variables: noise or music? J Am Coll Cardiol. 1989;14:1139-1148.
82. Malliani A, Lombardi F, Pagani M. Power spectral analysis of heart rate variability: a tool to explore neural regulatory mechanisms. Br Heart J. 1994;71:1-2.
83. Malik M, Camm AJ. Heart rate variability and clinical cardiology. Br Heart J. 1994;71:3-6.
84. Casolo GC, Stroder P, Signorini C, Calzolari F, Zucchini M, Balli E, Sulla A, Lazzerini S. Heart rate variability during the acute phase of myocardial infarction. Circulation. 1992;85:2073-2079.
85. Schwartz PJ, Vanoli E, Stramba-Badiale M, De Ferrari GM, Billman GE, Foreman RD. Autonomic mechanisms and sudden death: new insights from the analysis of baroreceptor reflexes in conscious dogs with and without a myocardial infarction. Circulation. 1988;78:969-979.
86. Malliani A, Schwartz PJ, Zanchetti A. A sympathetic reflex elicited by experimental coronary occlusion. Am J Physiol. 1969; 217:703-709.
87. Brown AM, Malliani A. Spinal sympathetic reflexes initiated by coronary receptors. J Physiol. 1971;212:685-705.
88. Malliani A, Recordati G, Schwartz PJ. Nervous activity of afferent cardiac sympathetic fibres with atrial and ventricular endings. J Physiol (Lond). 1973;229:457-469.
89. Bigger JT Jr, Fleiss JL, Rolnitzky LM, Steinman RC, Schneider WJ. Time course of recovery of heart period variability after myocardial infarction. J Am Coll Cardiol. 1991;18:1643-1649.
90. Lombardi F, Sandrone G, Pernpruner S, Sala R, Garimoldi M, Cerutti S, Baselli G, Pagani M, Malliani A. Heart rate variability as an index of sympathovagal interaction after myocardial infarction. Am J Cardiol. 1987;60:1239-1245.
91. Lombardi F, Sandrone G, Mortara A, La Rovere MT, Colombo E, Guzzetti S, Malliani A. Circadian variation of spectral indices of heart rate variability after myocardial infarction. Am Heart J. 1992; 123:1521-1529.
92. Kamath MV, Fallen EL. Diurnal variations of neurocardiac rhythms in acute myocardial infarction. Am J Cardiol. 1991;68: 155-160.
93. Bigger JT Jr, Fleiss JL, Steinman RC, Rolnitzky LM, Kleiger RE, Rottman JN. Frequency domain measures of heart period variability and mortality after myocardial infarction. Circulation. 1992; 85:164-171.
94. Ewing DJ, Neilson JMM, Traus P. New method for assessing cardiac parasympathetic activity using 24-hour electrocardiograms. Br Heart J. 1984;52:396-402.
95. Kitney RI, Byrne S, Edmonds ME, Watkins PJ, Roberts VC. Heart rate variability in the assessment of autonomic diabetic neuropathy. Automedica. 1982;4:155-167.
96. Pagani M, Malfatto G, Pierini S, Casati R, Masu AM, Poli M, Guzzetti S, Lombardi F, Cerutti S, Malliani A. Spectral analysis of heart rate variability in the assessment of autonomic diabetic neuropathy. J Auton Nerv Syst. 1988;23:143-153.
97. Freeman R, Saul JP, Roberts MS, Berger RD, Broadbridge C, Cohen RJ. Spectral analysis of heart rate in diabetic neuropathy. Arch Neurol. 1991;48:185-190.
98. Bernardi L, Ricordi L, Lazzari P, Solda P, Calciati A, Ferrari MR, Vandea I, Finardi G, Frantino P. Impaired circulation modulation of sympathovagal modulation of sympathovagal activity in diabetes. Circulation. 1992;86:1443-1452.
99. Bernardi L, Salvucci F, Suardi R, Soldá PL, Calciati A, Perlini S, Falcone C, Ricciardi L. Evidence for an intrinsic mechanism regulating heart rate variability in the transplanted and the intact heart during submaximal dynamic exercise? Cardiovasc Res. 1990; 24:969-981.
100. Sands KE, Appel ML, Lilly LS, Schoen FJ, Mudge GH Jr, Cohen RJ. Power spectrum analysis of heart rate variability in human cardiac transplant recipients. Circulation. 1989;79:76-82.
101. Fallen EL, Kamath MV, Ghista DN, Fitchett D. Spectral analysis of heart rate variability following human heart transplantation: evidence for functional reinnervation. J Auton Nerv Syst. 1988;23: 199-206.
102. Casolo G, Balli E, Taddei T, Amuhasi J, Gori C. Decreased spontaneous heart rate variability on congestive heart failure. Am J Cardiol. 1989;64:1162-1167.
103. Nolan J, Flapan AD, Capewell S, MacDonald TM, Neilson JMM, Ewing DJ. Decreased cardiac parasympathetic activity in chronic heart failure and its relation to left ventricular function. Br Heart J. 1992;69:761-767.
104. Kienzle MG, Ferguson DW, Birkett CL, Myers GA, Berg WJ, Mariano DJ. Clinical hemodynamic and sympathetic neural correlates of heart rate variability in congestive heart failure. Am J Cardiol. 1992;69:482-485.
105. Mortara A, La Rovere MT, Signorini MG, Pantaleo P, Pinna G, Martinelli L, Ceconi C, Cerutti S, Tavazzi L. Can power spectral analysis of heart rate variability identify a high risk subgroup of congestive heart failure patients with excessive sympathetic activation? A pilot study before and after heart transplantation. Br Heart J. 1994;71:422-430.
106. Gordon D, Herrera VL, McAlpine L, Cohen RJ, Akselrod S, Lang P, Norwood WI. Heart rate spectral analysis: a noninvasive probe of cardiovascular regulation in critically ill children with heart disease. Pediatr Cardiol. 1988;9:69-77.
107. Inoue K, Miyake S, Kumashiro M, Ogata H, Yoshimura O. Power spectral analysis of heart rate variability in traumatic quadriplegic humans. Am J Physiol. 1990;258:H1722-H1726.
108. Koh J, Brown TE, Beightol LA, Ha CY, Eckberg DL. Human autonomic rhythms: vagal cardiac mechanisms in tetraplegic patients. J Physiol (Lond). 1994;474.3:483-495.
109. Guzzetti S, Cogliati C, Broggi C, Carozzi C, Caldirolo D, Lombardi F, Malliani A. Heart period and arterial pressure variabilities in quadriplegic patients. Am J Physiol. 1994;266: H1112-H1120.
110. Algra A, Tijssen JGP, Roelandt JRTC, Pool J, Lubsen J. Heart rate variability from 24-hour electrocardiography and the 2-year risk for sudden death. Circulation. 1993;88:180-185.
111. Schwartz PJ, De Ferrari GM. Interventions changing heart rate variability after acute myocardial infarction. In: Malik M, Camm AJ, eds. Heart Rate Variability. Armonk, NY: Futura; 1995: 407-420.
112. De Ferrari GM, Vanoli E, Schwartz PJ. Cardiac vagal activity, myocardial ischemia and sudden death. In: Zipes DP, Jalife J, eds. Cardiac Electrophysiology: From Cell to Bedside. Philadelphia, Pa: WB Saunders Co; 1995:422-434.
113. Molgaard H, Mickley H, Pless P, Bjerregaard P, Moller M. Effects of metoprolol on heart rate variability in survivors of acute myocardial infarction. Am J Cardiol. 1993;71:1357-1359.
114. Sandrone G, Mortara A, Torzillo D, La Rovere MT, Malliani A, Lombardi F. Effects of beta blockers (atenolol or metoprolol) on heart rate variability after acute myocardial infarction. Am J Cardiol. 1994;74:340-345.
115. Adamson PB, Huang MH, Vanoli E, Foreman RD, Schwartz PJ, Hull SS Jr. Unexpected interaction between β-adrenergic blockade and heart rate variability before and after myocardial infarction: a longitudinal study in dogs at high and low risk for sudden death. Circulation. 1994;90:976-982.
116. Zuanetti G, Latini R, Neilson JMM, Schwartz PJ, Ewing DJ, and the Antiarrhythmic Drug Evaluation Group (ADEG). Heart rate variability in patients with ventricular arrhythmias: effect of antiarrhythmic drugs. J Am Coll Cardiol. 1991;17:604-612.
117. Lombardi F, Torzillo D, Sandrone G, Dalla Vecchia L, Finocchiaro ML, Bernasconi R, Cappiello E. Beta-blocking effect of propafenone based on spectral analysis of heart rate variability. Am J Cardiol. 1992;70:1028-1034.
118. Bigger JT Jr, Rolnitzky LM, Steinman RC, Fleiss JL. Predicting mortality after myocardial infarction from the response of RR variability to antiarrhythmic drug therapy. J Am Coll Cardiol. 1994; 23:733-740.
119. Casadei B, Pipilis A, Sessa F, Conway J, Sleight P. Low doses of scopolamine increase cardiac vagal tone in the acute phase of myocardial infarction. Circulation. 1993;88:353-357.
120. De Ferrari GM, Mantica M, Vanoli E, Hull SS Jr, Schwartz PJ. Scopolamine increases vagal tone and vagal reflexes in patients after myocardial infarction. J Am Coll Cardiol. 1993;22:1327-1334.
121. Pedretti R, Colombo E, Sarzi Braga S, Car B. Influence of transdermal scopolamine on cardiac sympathovagal interaction after acute myocardial infarction. Am J Cardiol. 1993;72:384-392.
122. Vybiral T, Glaser DH, Morris G, Hess KR, Yang K, Francis M, Pratt CM. Effects of low dose scopolamine on heart rate variability in acute myocardial infarction. J Am Coll Cardiol. 1993;22: 1320-1326.
123. La Rovere MT, Mortara A, Pantaneleo P, Maestri R, Cobelli F, Tavazzi L. Scopolamine improves autonomic balance in advanced congestive heart failure. Circulation. 1994;90:838-843.
124. Hull SS Jr, Vanoli E, Adamson PB, De Ferrari GM, Foreman RD, Schwartz PJ. Do increase in markers of vagal activity imply proteclion from sudden death? The case of scopolamine. Circulation. 1995;91:2516-2519.
125. Zabel M, Klingenheben T, Hohnloser SH. Changes in autonomic tone following thrombolytic therapy for acute myocardial infarction: assessment by analysis of heart rate variability. J Curdiovasc Electrophysiol. 1994;5:211-218.
126. O'Connor GT, Buring JE, Yusuf S, Goldhaber SZ, Olmstead EM, Paffenbarger RS Jr, Hennekens CH. An overview of randomized trials of rehabilitation with exercise after myocardial infarction. Circulation. 1989;80:234-244.
127. Furlan R, Piazza D, Dell'Orto S, Gentile E, Cerutti S, Pagani M, Malliani A. Early and late effects of exercise and athletic training on neural mechanisms controlling heart rate. Cardiovasc Res. 1993;27:482-488.
128. Arai Y, Saul JP, Albrecht P, Hartley LH, Lilly LS, Cohen RJ, Colucci WS. Modulation of cardiac autonomic activity during and immediately after exercise. Am J Physiol. 1989;256:H132-H141.
129. Hull SS Jr, Vanoli E, Adamson PB, Verrier RL, Foreman RD, Schwartz PJ. Exercise training confers anticipatory protection from sudden death during acute myocardial ischemia. Circulation. 1994;89:548-552.
130. La Rovere MT, Mortara A, Sandrone G, Lombardi F. Autonomic nervous system adaptation to short-term exercise training. Chest. 1992;101:299-303.
131. Odemuyiwa O, Malik M, Farrell T, Bashir Y, Poloniecki J, Camm J. Comparison of the predictive characteristics of heart rate variability index and left ventricular ejection fraction for all-cause mortality, arrhythmic events and sudden death after acute myocardial infarction. Am J Cardiol. 1991;68:434-439.
132. Greene HL, Richardson DW, Barker AH, Roden DM, Capone RJ, Echt DS, Friedman LM, Gillespie MJ, Hallstrom AP, Verter J, and the CAPS Investigators. Classification of deaths after myocardial infarction as arrhythmic or nonarrhythmic (the Cardiac Arrhythmia Pilot Study). Am J Cardiol. 1989;63:1-6.
133. Malik M, Camm AJ. Significance of long-term components of heart rate variability for the further prognosis after acute myocardial infarction. Cardiovasc Res. 1990;24:793-803.
134. Malik M, Farrell T, Camm AJ. Circadian rhythm of heart rate variability after acute myocardial infarction and its influence on the prognostic value of heart rate variability. Am J Cardiol. 1990; 66:1049-1054.
135. Bigger JT, Fleiss JL, Rolnitzky LM, Steinman RC. The ability of several short-term measures of RR variability to predict mortality after myocardial infarction. Circulation. 1993;88:927-934.
136. Fei L, Malik M. Short- and long-term assessment of heart rate variability for postinfarction risk stratification. In: Malik M, Camm AJ, eds. Heart Rate Variability. Armonk, NY: Futura; 1995: 341-346.
137. Bigger JT, Kleiger RE, Fleiss JL, Rolnitzky LM, Steinman RC, Miller JP, and the Multicenter Post-Infarction Research Group. Components of heart rate variability measured during healing of acute myocardial infarction. Am J Cardiol. 1988;61:208-215.
138. Bigger JT, Fleiss JL, Rolnitzky LM, Steinman RC. Frequency domain measures of heart period variability to assess risk late after myocardial infarction. J Am Coll Cardiol. 1993;21:729-736.
139. Camm AJ, Fei L. Risk stratification following myocardial infarction: heart rate variability and other risk factors. In: Malik M, Camm AJ, eds. Heart Rate Variability. Armonk, NY: Futura; 1995:369-392.
140. Bannister R. Autonomic Failure. A Textbook of Clinical Disorders of the Autonomic Nervous System. Oxford/New York: Oxford University Press; 1988.
141. Ewing DJ, Campbell IW, Clarke BF. The natural history of diabetic autonomic neuropathy. Q J Med. 1980;193:95-108.
142. Smith S. Reduced sinus arrhythmia in diabetic autonomic neuropathy: diagnostic value of an age related normal range. Br Med J. 1982;285:1599-1601.
143. O'Brien IA, O'Hare P, Corrall RJM. Heart rate variability in healthy subjects: effect of age and the derivation of normal ranges for tests of autonomic function. Br Heart J. 1986;55:348-354.
144. Ewing DJ, Neilson JMM, Shapiro JA, Reid W. Twenty four hour heart rate variability: effects of posture, sleep and time of day in healthy controls and comparison with bedside tests of autonomic function in diabetic patients. Br Heart J. 1991;65:239-244.
145. Malpas SC, Maling TJB. Heart rate variability and cardiac autonomic function in diabetes. Diabetes. 1990;39:1177-1181.
146. Bianchi A, Bontempi B, Cerutti S, Gianoglio P, Comi G, Natali Sora MG. Spectral analysis of heart rate variability signal and respiration in diabetic subjects. Med Biol Eng Comput. 1990;28: 205-211.
147. Bellavere F, Balzani I, De Masi G, Carraro M, Carenza P, Cobelli C, Thomaseth K. Power spectral analysis of heart rate variation improves assessment of diabetic cardiac autonomic neuropathy. Diabetes. 1992;41:633-640.
148. Van den Akker TJ, Koelman ASM, Hogenhuis LAH, Rompelman G. Heart rate variability and blood pressure oscillations in diabetics with autonomic neuropathy. Automedica. 1983;4:201-208.
149. Guzzetti S, Dassi S, Pecis M, Casati R, Masu AM, Longoni P, Tinelli M, Cerutti S, Pagani M, Malliani A. Altered pattern of circadian neural control of heart period in mild hypertension. J Hypertens. 1991;9:831-838.
150. Langewitz W, Ruddel H, Schachinger H. Reduced parasympathetic cardiac control in patients with hypertension at rest and under mental stress. Am Heart J. 1994;127:122-128.
151. Saul JP, Arai Y, Berger RD, Lily LS, Wilson S, Colucci WS, Cohen RJ. Assessment of autonomic regulation in chronic congestive heart failure by the heart rate spectral analysis. Am J Cardiol. 1988;61:1292-1299.
152. Binkley PF, Nunziata E, Haas GJ, Nelson SD, Cody RJ. Parasympathetic withdrawal is an integral component of autonomic imbalance in congestive heart failure: demonstration in human subjects and verification in a paced canine model of ventricular failure. J Am Coll Cardiol. 1991;18:464-472.
153. Townend JN, West JN, Davies MK, Littler WA. Effect of quinapril on blood pressure and heart rate in congestive heart failure. Am J Cardiol. 1992;69:1587-1590.
154. Binkley PF, Haas GJ, Starling RC, Nunziata E, Hatton PA, Leier CV, Cody JR. Sustained augmentation of parasympathetic tone with angiotensin converting enzyme inhibitor in patients with congestive heart failure. J Am Coll Cardiol. 1993;21:655-661.
155. Woo MA, Stevenson WG, Moser DK, Middlekauff HR. Complex heart rate variability and serum norepinephrine levels in patients with advanced heart failure. J Am Coll Cardiol. 1994;23:565-569.
156. Alexopoulos D, Yusuf S, Johnston JA, Bostock J, Sleight P, Yacoub MH. The 24-hour heart rate behavior in long-term survivors of cardiac transplantation. Am J Cardiol. 1988;61:880-884.
157. Stein KM, Bores JS, Hochreites C, Okin PM, Herrold EM, Devereux RB, Kligfield P. Prognostic value and physiological correlates of heart rate variability in chronic severe mitral regurgitation. Circulation. 1993;88:127-135.
158. Marangoni S, Scalvini S, Mai R, Quadri A, Levi GF. Heart rate variability assessment in patients with mitral valve prolapse syndrome. Am J Noninvas Cardiol. 1993;7:210-214.
159. Counihan PJ, Fei L, Bashir Y, Farrel TG, Haywood GA, McKenna WJ. Assessment of heart rate variability in hypertrophic cardiomyopathy: association with clinical and prognostic features. Circulation. 1993;88:1682-1690.
160. Dougherty CM, Burr RL. Comparison of heart rate variability in survivors and nonsurvivors of sudden cardiac arrest. Am J Cardiol. 1992;70:441-448.
161. Huikuri HV, Linnaluoto MK, Seppanen T, Airaksinen KEJ, Kessler KM, Takkunen JT, Myerburg RJ. Circadian rhythm of heart rate variability in survivors of cardiac arrest. Am J Cardiol. 1992;70:610-615.
162. Myers GA, Martin GJ, Magid NM, Barnett PS, Schaad JW, Weiss JS, Lesch M, Singer DH. Power spectral analysis of heart rate variability in sudden cardiac death: comparison to other methods. IEEE Trans Biomed Eng. 1986;33:1149-1156.
163. Martin GJ, Magid NM, Myers G, Barnett PS, Schaad JW, Weiss JS, Lesch M, Singer DH. Heart rate variability and sudden death secondary to coronary artery disease during ambulatory ECG monitoring. Am J Cardiol. 1986;60:86-89.
164. Vybiral T, Glaeser DH, Goldberger AL, Rigney DR, Hess KR, Mietus J, Skinner JE, Francis M, Pratt CM. Conventional heart rate variability analysis of ambulatory electrocardiographic recordings fails to predict imminent ventricular fibrillation. J Am Coll Cardiol. 1993;22:557-565.
165. Huikuri HV, Valkama JO, Airaksinen KEJ, Seppanen T, Kessler KM, Takkunen JT, Myerburg RJ. Frequency domain measures of heart rate variability before the onset of nonsustained and sustained ventricular tachycardia in patients with coronary artery disease. Circulation. 1993;87:1220-1228.
166. Hohnloser SH, Klingenheben T, van de Loo A, Hablawetz E, Just H, Schwartz PJ. Reflex versus tonic vagal activity as a prognostic parameter in patients with sustained ventricular tachycardia or ventricular fibrillation. Circulation. 1994;89:1068-1073.
167. Kocovic DZ, Harada T, Shea JB, Soroff D, Friedman PL. Alterations of heart rate and of heart rate variability after radiofrequency catheter ablation of supraventricular tachycardia. Circulation. 1993;88:1671-1681.
168. Lefler CT, Saul JP, Cohen RJ. Rate-related and autonomic effects on atrioventricular conduction assessed through beat-to-beat PR interval and cycle length variability. J Cardiovasc Electrophysiol. 1994;5:2-15.
169. Berger RD, Saul JP, Cohen RJ. Assessment of autonomic response by broad-band respiration. IEEE Trans Biomed Eng. 1989;36:1061-1065.
170. Berger RD, Saul JP, Cohen RJ. Transfer function analysis of autonomic regulation, I: the canine atrial rate response. Am J Physiol. 1989;256:H142-H152.
171. Saul JP, Berger RD, Chen MH, Cohen RJ. Transfer function analysis of autonomic regulation, II: respiratory sinus arrhythmia. Am J Physiol. 1989;256:H153-H161.
172. Saul JP, Berger RD, Albrecht P, Stein SP, Chen MH, Cohen RJ. Transfer function analysis of the circulation: unique insights into cardiovascular regulation. Am J Physiol. 1991;261:H1231-H1245.
173. Baselli G, Cerutti S, Civardi S, Malliani A, Pagani M. Cardiovascular variability signals: towards the identification of a closed-loop model of the neural control mechanisms. IEEE Trans Biomed Eng. 1988;35:1033-1046.
174. Appel ML, Saul JP, Berger RD, Cohen RJ. Closed loop identification of cardiovascular circulatory mechanisms. In: Computers in Cardiology 1989. Los Alamitos, Calif: IEEE Press; 1990:3-7.
175. Tsuji H, Venditti FJ, Manders ES, Evans JC, Larson MG, Feldman CL, Levy D. Reduced heart rate variability and mortality risk in an elderly cohort: the Framingham Heart Study. Circulation. 1994;90:878-883.
176. Vanoli E, Adamson PB, Lin B, Pinna GD, Lazzara R, Or WC. Heart rate variability during specific sleep stages: a comparison of healthy subjects with patients after myocardial infarction. Circulation. 1995;91:1918-1922.
177. Singer DH, Ori Z. Changes in heart rate variability associated with sudden cardiac death. In: Malik M, Camm AJ, eds. Heart Rate Variability. Armonk, NY: Futura; 1995:429-448.
178. Malfatto, G, Rosen TS, Steinberg SF, Ursell PC, Sun LS, Daniel S, Danilo P Jr, Rosen MR. Sympathetic neural modulation of cardiac impulse initiation and repolarization in the newborn rat. Circ Res. 1990;66:427-437.
179. Hirsch M, Karin J, Akselrod S. Heart rate variability in the fetus. In: Malik M, Camm AJ, eds. Heart Rate Variability. Armonk, NY: Futura; 1995:517-531.
180. Parati G, Di Rienzo M, Groppelli A, Pedotti A, Mancia G. Heart rate and blood pressure variability and their interaction in hypertension. In: Malik M, Camm AJ, eds. Heart Rate Variability. Armonk, NY: Futura; 1995:465-478.
181. Bigger JT Jr, Fleiss JL, Steinman RC, Rolnitzky LM, Schneider WJ, Stein PK. RR variability in healthy, middle-age persons compared with patients with chronic coronary heart disease or recent acute myocardial infarction. Circulation. 1995;91: 1936-1943.