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Evaluation of heart rate variability

Ary L Goldberger, MD
Phyllis K Stein, PhD
Section Editor
Leonard I Ganz, MD, FHRS, FACC
Deputy Editor
Brian C Downey, MD, FACC


Evaluation of beat-to-beat heart rate dynamics, as a noninvasive albeit indirect probe of autonomic nervous system function, is of interest from a number of basic perspectives with potential translational applications. For example, a large body of clinical and experimental evidence that indicates an important role for the autonomic nervous system in the triggering or sustaining of malignant ventricular arrhythmias [1]. Higher sympathetic activity unopposed by vagal activity promotes arrhythmia in a variety of ways:

Reducing ventricular refractory period and the ventricular fibrillation threshold

Promoting triggered activity afterpotentials

Enhancing automaticity (see "Enhanced cardiac automaticity")

Vagal stimulation opposes these changes and reduces the effects of sympathetic stimulation by prolonging refractoriness, elevating the ventricular fibrillation threshold, and reducing automaticity. (See "Pathogenesis of ventricular arrhythmias in heart failure and cardiomyopathy", section on 'Pathogenesis'.)

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Literature review current through: Sep 2017. | This topic last updated: Oct 06, 2017.
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