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(Circulation. 2000;101:8.)
© 2000 American Heart Association, Inc.

Editorials

Chaos Theory, Heart Rate Variability, and Arrhythmic Mortality

Federico Lombardi, MD, FESC

From Cardiologia, Dipartimento di Medicina, Chirurgia e Odontoiatria, Ospedale San Paolo, Università degli Studi di Milano, Italy.

Correspondence to Prof Federico Lombardi, MD, FESC, Cardiologia, Dipartimento di Medicina, Chirurgia, e Odontoiatria, Ospedale San Paolo, University of Milan, Via A. di Rudini, 8, 20142 Milan, Italy. E-mail federico.lombardi@unimi.it

Key Words: Editorials • heart rate • nervous system, autonomic • myocardial infarction

Physiological rhythms are central to life. Some rhythms are maintained throughout life, and even a brief interruption leads to death. Glass and Mackey¹

Since the original report by Wolf et al,² analysis of spontaneous variations of beat-to-beat intervals has become a valuable tool, familiar to clinical cardiologists.

In 1987, Kleiger and coworkers³ published a pioneering work demonstrating that a reduced heart rate variability (HRV) was capable of identifying a subgroup of subjects with increased cardiac mortality after myocardial infarction (MI) and that its predictive value was independent of traditional clinical risk-stratifying factors. It was originally proposed that reduction in HRV might reflect, at the sinus node level, an autonomic imbalance characterized by increased sympathetic and reduced vagal activity. This interpretation was also supported by indirect findings, such as a tendency toward faster heart rates and a smaller day-night heart rate difference observed in these patients.

This initial observation was followed by several reports⁴ in which time-domain parameters or geometric indices of HRV, measured on Holter recordings, were found to be effective in identifying post-MI patients with increased cardiac mortality. Unfortunately, when sensitivity and specificity were determined, their value was less than expected, with a positive predictive value <30%. The confounding effect of the variety of computation methodologies present in commercial instrumentation also contributed to the limited application of this methodology in routine clinical practice.⁴

In 1987, spectral analysis of HRV was applied to post-MI patients.^{4 5 6 7 8} The complexity of computation was partially compensated for by the capability of spectral methodology to . . . [Full Text of this Article]

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