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Autonomic dysfunction and heart rate variability with Holter monitoring: a diagnostic look at autonomic regulation

Autonome Dysfunktion und Herzfrequenzvariabilität mit Holter-Überwachung: ein diagnostischer Blick auf die autonome Regulation

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Abstract

Heart rate variability (HRV) refers to the beat-to-beat variation of the cardiac cycle. Since heart rate is modulated on a beat-to-beat basis by the combined influence of the sympathetic and parasympathetic nervous system at the sinus node level, HRV has been considered an indirect biomarker of cardiac autonomic control and widely exploited for the assessment of autonomic function in many pathological subjects. This focus article summarizes the main findings derived from HRV analysis applied to 24‑h Holter monitoring in both cardiac and non-cardiac diseases as well as in physiological conditions in the healthy population. Even if the prognostic role of HRV indices is well recognized and its use ever more widespread, its implementation in the diagnostic and prognostic processes in routine clinical practice remains limited. Several reasons for these limitations can be identified: first the lack of reliable reference values, and secondly, the low specificity of HRV indices in particular when considering the constant evolution of clinical practice and therapeutic approaches, making it difficult to refer to a specific and stable combination of clinical and HRV markers. Therefore, the clinical use of HRV should be further investigated. Finally, HRV represents a substantial tool for investigating the physiological conditions in healthy people that can have important implications in primary prevention and the understanding of gender differences, as well as in sport and occupational medicine.

Zusammenfassung

Der Begriff Herzfrequenzvariabilität (HRV [„heart rate variability“]) beschreibt die Schlag-zu-Schlag-Variationen des Herzzyklus. Da die Herzfrequenz auf Schlag-zu-Schlag-Basis durch den kombinierten Einfluss des sympathischen und parasympathischen Nervensystems auf Sinusknotenebene reguliert wird, wurde die HRV als indirekter Biomarker der kardialen autonomen Kontrolle angesehen und in vielen pathologischen Themenbereichen zur Bewertung der autonomen Funktion genutzt. Im vorliegenden Beitrag sind die HRV-Hauptbefunde zusammengefasst, die aus einer Analyse von 24-h-Holter-Überwachungen stammen, die sowohl bei Menschen mit kardialen als auch nichtkardialen Erkrankungen sowie unter physiologischen Bedingungen in einer gesunden Population durchgeführt wurden. Auch wenn die prognostische Rolle der HRV-Indizes allgemein anerkannt ist und ihr Einsatz immer weiter verbreitet wird, bleibt ihre Implementierung in die diagnostischen und prognostischen klinischen Routineprozesse begrenzt. Hierfür lassen sich verschiedene Gründe anführen: zum einen das Fehlen verlässlicher Referenzwerte, zum anderen die niedrige Spezifität der HRV-Indizes, insbesondere unter Berücksichtigung der fortwährenden Weiterentwicklung der klinischen Praxis und therapeutischen Möglichkeiten, die es schwierig machen, eine spezifische und stabile Kombination klinischer und herzfrequenzassoziierter Marker zu benennen. Deshalb sollte der klinische Einsatz der HRV weiter untersucht werden. Schließlich stellt sie auch ein wesentliches Instrument zur Untersuchung der physiologischen Bedingungen bei gesunden Menschen dar, das wesentliche Auswirkungen auf die Primärprävention und das Verständnis von geschlechtsspezifischen Unterschieden, ebenso auch für die Sport- und Arbeitsmedizin haben kann.

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Authors and Affiliations

  1. IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italien

    Beatrice De Maria & Laura Adelaide Dalla Vecchia

  2. Department of Biomedical Sciences for Health, University of Milan, Milan, Italien

    Alberto Porta

  3. Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italien

    Alberto Porta

  4. Department of Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Via per Montescano, 27040, Montescano (Pavia), Italien

    Maria Teresa La Rovere

Authors
  1. Beatrice De Maria
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  2. Laura Adelaide Dalla Vecchia
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  3. Alberto Porta
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  4. Maria Teresa La Rovere
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Correspondence to Maria Teresa La Rovere.

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Conflict of interest

B. De Maria, L.A. Dalla Vecchia, A. Porta and M.T. La Rovere declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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De Maria, B., Dalla Vecchia, L.A., Porta, A. et al. Autonomic dysfunction and heart rate variability with Holter monitoring: a diagnostic look at autonomic regulation. Herzschr Elektrophys 32, 315–319 (2021). https://doi.org/10.1007/s00399-021-00780-5

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