About Heart Rate Variability

Heart rate variability (HRV) describes the variations between consecutive inter-beat-intervals or IBIs. Both sympathetic and parasympathetic branches of the autonomic nervous system (ANS) are involved in the regulation of heart rate (HR). Sympathetic nervous system (SNS) activity increases HR and decreases HRV, whereas parasympathetic nervous system (PNS) activity decreases HR and increases HRV Berntson et al. 1997. The control of the autonomic output involves several interconnected areas of central nervous system, which form the so-called central autonomic network. In addition to this central control, arterial baroreceptor reflex as well as respiration are known to induce quick changes in heart rate. The baroreflex is based on baroreceptors which are located on the walls of some large vessels and can sense the stretching of vessel walls caused by pressure increase. Both sympathetic and parasympathetic activity are influenced by baroreceptor stimulation trough a specific baroreflex arc (see Fig. 1).

Baroreceptor reflex

Figure 1: Functioning of the barorelfex arc.

Typically, the most conspicuous oscillatory component of HRV is the respiratory sinus arrhythmia (RSA), where the vagus nerve stimulation is being cut-off during inhalation, and thus, HR increases during inhalation and decreases during exhalation (see video below). This high frequency (HF) component of HRV is thus centered at respiratory frequency and is considered to range from 0.15 to 0.4 Hz. Another conspicuous component of HRV is the low frequency (LF) component ranging from 0.04 to 0.15 Hz. The HF component is mediated almost solely by the PNS activity, whereas the LF component is mediated by both SNS and PNS activities and is also affected by baroreflex activity Task Force 1996Berntson et al. 1997 . The origin of the LF oscillations is however considered to be dominated by SNS and the normalized power of the LF component could be used to assess sympathetic efferent activity Pagani et al. 1997Furlan et al. 2000. The fluctuations below 0.04 Hz, on the other hand, have not been studied as much as the higher frequencies. These frequencies are commonly divided into very low frequency (VLF, 0.003-0.04 Hz) and ultra low frequency (ULF, 0-0.003 Hz) bands, but in case of short-term recordings the ULF band is generally omitted Task Force 1996. These lowest frequency rhythms are characteristic for HRV signals and have been related to, e.g., humoral factors such as the thermoregulatory processes and renin-angiotensin system Berntson et al. 1997.

Heart rate variability is a commonly used tool when trying to assess the functioning of cardiac autonomic regulation. It has been used in multitude of studies, related to cardiovascular research and different human wellbeing applications, as an indirect tool to evaluate the functioning and balance of the autonomic nervous system (ANS).

One of the main clinical scenarios where heart rate variability has been found valuable include the risk stratification of sudden cardiac death after acute myocardial infarction Task Force 1996Acharya et al. 2006Laitio et al. 2007Pradhapan et al. 2014. In addition, decreased HRV is generally accepted to provide an early warning sign of diabetic cardiovascular autonomic neuropathy Task Force 1996Acharya et al. 2006, the most significant decrease in HRV being found within the first 5-10 years of diabetes Vinik et al. 2013Tarvainen et al. 2014. Besides these two main clinical scenarios, HRV has been studied with relation to several cardiovascular diseases, renal failure, physical exercise, occupational and psychosocial stress, gender, age, drugs, alcohol, smoking and sleep van Ravenswaaij-Arts et al. 1993Malik et al. 1993Task Force 1996Pumprla et al. 2002Achten et al. 2003Acharya et al. 2006.


  1. U.R. Acharya, K.P. Joseph, N. Kannathal, C.M. Lim, and J.S. Suri. Heart rate variability: a review. Med Biol Eng Comput, 44:1031–1051, 2006.
  2. J. Achten and A.E. Jeukendrup. Heart rate monitoring – applications and limitations. Sports Med, 33(7):517–538, 2003.
  3. G.G. Berntson, J.T. Bigger Jr., D.L. Eckberg, P. Grossman, P.G. Kaufmann, M. Malik, H.N. Nagaraja, S.W. Porges, J.P. Saul, P.H. Stone, and M.W. Van Der Molen. Heart rate variability: Origins, methods, and interpretive caveats. Psychophysiol, 34:623–648, 1997.
  4. R. Furlan, A. Porta, F. Costa, J. Tank, L. Baker, R. Schiavi, D. Robertson, A. Malliani, and R. Mosqueda-Garcia. Oscillatory patterns in sympathetic neural discharge and cardiovascular variables during orthostatic stimulus. Circulation, 101:886–892, 2000.
  5. T. Laitio, J. Jalonen, T. Kuusela, and H. Scheinin. The role of heart rate variability in risk stratification for adverse postoperative cardiac events. Anesth Analg, 105(6):1548–1560, 2007.
  6. M. Malik and A.J. Camm. Components of heart rate variability – what they really mean and what we really measure. Am J Cardiol, 72(11):821–822, 1993.
  7. M. Pagani, N. Montano, A. Porta, A. Malliani, , F.M. Abboud, C. Birkett, and V.K. Somers. Relationship between spectral components of cardiovascular variabilities and direct measures of muscle sympathetic nerve activity in humans. Circulation, 95:1441–1448, 1997.
  8. O. Pradhapan, M.P. Tarvainen, T. Nieminen, R. Lehtinen, K. Nikus, T. Lehtimäki, M. Kähönen, and J. Viik. Effect of heart rate correction on pre- and post-exercise heart rate variability to predict risk of mortality – an experimental study on the FINCAVAS cohort. Frontiers in Physiology, 5(Article 208):1–9, 2014.
  9. J. Pumprla, K. Howorka, D. Groves, M. Chester, and J. Nolan. Functional assessment of heart rate variability: physiological basis and practical applications. Int J Cardiol, 84:1–14, 2002.
  10. J.A. Richman and J.R. Moorman. Physiological time-series analysis using approximate entropy and sample entropy. Am J Physiol, 278:H2039–H2049, 2000.
  11. M.P. Tarvainen, T.P. Laitinen, J.A. Lipponen, D.J. Cornforth, , and H.F. Jelinek. Cardiac autonomic dysfunction in type 2 diabetes – effect of hyperglycemia and disease duration. Frontiers in Endocrinology, 5(Article 130):1–9, 2014.
  12. Task force of the European society of cardiology and the North American society of pacing and electrophysiology. Heart rate variability – standards of measurement, physiological interpretation, and clinical use. Circulation, 93(5):1043–1065, March 1996.
  13. C.M.A. van Ravenswaaij-Arts, L.A.A. Kollée, J.C.W. Hopman, G.B.A. Stoelinga, and H.P. van Geijn. Heart rate variability. Ann Intern Med, 118(6):436–447, 1993.
  14. A.I. Vinik, T. Erbas, and C.M. Casellini. Diabetic cardiac autonomic neuropathy, inflammation and cardiovascular disease. J Diabetes Investig, 4(1):4–8, 2013.