A healthy heart is not a metronome: an integrative review of the heart's anatomy and heart rate variability

Fred Shaffer, Rollin McCraty, Christopher L Zerr, Fred Shaffer, Rollin McCraty, Christopher L Zerr

Abstract

Heart rate variability (HRV), the change in the time intervals between adjacent heartbeats, is an emergent property of interdependent regulatory systems that operate on different time scales to adapt to challenges and achieve optimal performance. This article briefly reviews neural regulation of the heart, and its basic anatomy, the cardiac cycle, and the sinoatrial and atrioventricular pacemakers. The cardiovascular regulation center in the medulla integrates sensory information and input from higher brain centers, and afferent cardiovascular system inputs to adjust heart rate and blood pressure via sympathetic and parasympathetic efferent pathways. This article reviews sympathetic and parasympathetic influences on the heart, and examines the interpretation of HRV and the association between reduced HRV, risk of disease and mortality, and the loss of regulatory capacity. This article also discusses the intrinsic cardiac nervous system and the heart-brain connection, through which afferent information can influence activity in the subcortical and frontocortical areas, and motor cortex. It also considers new perspectives on the putative underlying physiological mechanisms and properties of the ultra-low-frequency (ULF), very-low-frequency (VLF), low-frequency (LF), and high-frequency (HF) bands. Additionally, it reviews the most common time and frequency domain measurements as well as standardized data collection protocols. In its final section, this article integrates Porges' polyvagal theory, Thayer and colleagues' neurovisceral integration model, Lehrer et al.'s resonance frequency model, and the Institute of HeartMath's coherence model. The authors conclude that a coherent heart is not a metronome because its rhythms are characterized by both complexity and stability over longer time scales. Future research should expand understanding of how the heart and its intrinsic nervous system influence the brain.

Keywords: biofeedback interventions; emotional self-regulation; heart rate variability; neurocardiology; psychophysiological coherence.

Figures

Figure 1
Figure 1
The generation of the electrocardiogram. Credit: Alila Sao Mai/Shutterstock.com.
Figure 2
Figure 2
The depolarization and repolarization of the heart. Credit: Alila Sao Mai/Shutterstock.com.
Figure 3
Figure 3
The neural communication pathways interacting between the heart and the brain are responsible for the generation of HRV. The intrinsic cardiac nervous system integrates information from the extrinsic nervous system and from the sensory neurites within the heart. The extrinsic cardiac ganglia located in the thoracic cavity have connections to the lungs and esophagus and are indirectly connected via the spinal cord to many other organs such as the skin and arteries. The vagus nerve (parasympathetic) primarily consists of afferent (flowing to the brain) fibers which connect to the medulla, after passing through the nodose ganglion. Credit: Institute of HeartMath.
Figure 4
Figure 4
Microscopic image of interconnected intrinsic cardiac ganglia in the human heart. The thin, light blue structures are multiple axons that connect the ganglia. Credit: Dr. Andrew Armour and the Institute of HeartMath.
Figure 5
Figure 5
This drawing shows the location and distribution of intrinsic cardiac ganglia which are interconnected and form the “heart brain.” Note how they are distributed around the orifices of the major vessels. Credit: Dr. Andrew Armour and the Institute of HeartMath.
Figure 6
Figure 6
Display of short-term HRV activity. Credit: Institute of HeartMath.
Figure 7
Figure 7
ECG electrode placement. Credit: Truman State University Center for Applied Psychophysiology.
Figure 8
Figure 8
This figure shows a typical HRV recording over a 15-min period during resting conditions in a healthy individual. The top trace shows the original HRV waveform. Filtering techniques were used to separate the original waveform into VLF, LF, and HF bands as shown in the lower traces. The bottom of the figure shows the power spectra (left) and the percentage of power (right) in each band. Credit: Institute of HeartMath.
Figure 9
Figure 9
Credit: Alila Sao Mai/Shutterstock.com.
Figure 10
Figure 10
Long-term single-neuron recordings from an afferent neuron in the intrinsic cardiac nervous system in a beating dog heart. The top row shows neural activity, the second row, the actual neural recording, and the third row, the left ventricular pressure. This intrinsic rhythm has an average period of 90 s with a range between 75 and 100 s (0.013–0.01 Hz), which falls within the VLF band. Credit: Dr. Andrew Armour and the Institute of HeartMath.
Figure 11
Figure 11
This figure shows the power in the various frequency bands for 24-h HRV and 95% confidence intervals for each of the bands. The left side of the figure reveals a number of slower rhythms that make up the ULF band. The analysis was conducted using the healthy sample described in Umetani et al. (1998). The right side of the figure shows an analysis of the same data performed on 5-min segments as is traditionally done. Credit: Institute of HeartMath.

References

    1. Agelink M. W., Boz C., Ullrich H., Andrich J. (2002). Relationship between major depression and heart rate variability. Clinical consequences and implications for antidepressive treatment. Psychiatry Res. 113, 139–149 10.1016/S0165-1781(02)00225-1
    1. Ahmed A. K., Harness J. B., Mearns A. J. (1982). Respiratory control of heart rate. Eur. J. Appl. Physiol. 50, 95–104 10.1007/BF00952248
    1. Akselrod S., Gordon D., Ubel F. A., Shannon D. C., Barger A. C., Cohen R. J. (1981). Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat-to-beat cardiovascular control. Science 213, 220–222 10.1126/science.6166045
    1. Alabdulgader A. A. (2012). Coherence: a novel nonpharmacological modality for lowering blood pressure in hypertensive patients. Glob. Adv. Health Med. 1, 56–64 10.7453/gahmj.2012.1.2.011
    1. Ardell J. L., Butler C. K., Smith F. M., Hopkins D. A., Armour J. A. (1991). Activity of in vivo atrial and ventricular neurons in chronically decentralized canine hearts. Am. J. Physiol. 260, H713–H721
    1. Ardell J. L., Cardinal R., Vermeulen M., Armour J. A. (2009). Dorsal spinal cord stimulation obtunds the capacity of intrathoracic extracardiac neurons to transduce myocardial ischemia. Am. J. Physiol. Regul. Integr. Comp. Physiol. 297, R470–R477 10.1152/ajpregu.90821.2008
    1. Armour J. A. (1991). Intrinsic cardiac neurons. J. Cardiovasc. Electrophysiol. 2, 331–341 10.1111/j.1540-8167.1991.tb01330.x
    1. Armour J. A. (2003). Neurocardiology: Anatomical and Functional Principles. Boulder Creek, CA: Institute of HeartMath
    1. Armour J. A. (2008). Potential clinical relevance of the “little brain” on the mammalian heart. Exp. Physiol. 93, 165–176 10.1113/expphysiol.2007.041178
    1. Armour J. A., Kember G. C. (2004). Cardiac sensory neurons, in Basic and Clinical Neurocardiology, eds Armour J. A., Ardell J. L. (New York, NY: Oxford University Press; ), 79–117
    1. Axelrod S., Lishner M., Oz O., Bernheim J., Ravid M. (1987). Spectral analysis of fluctuations in heart rate: an objective evaluation of autonomic nervous control in chronic renal failure. Nephron 45, 202–206 10.1159/000184117
    1. Baselli G., Cerutti S., Badilini F., Biancardi L., Porta A., Pagani M., et al. (1994). Model for the assessment of heart period and arterial pressure variability interactions and of respiration influences. Med. Biol. Eng. Comput. 32, 143–152 10.1007/BF02518911
    1. Beauchaine T. (2001). Vagal tone, development, and Gray's motivational theory: toward an integrated model of autonomic nervous system functioning in psychopathology. Dev. Psychopathol. 13, 183–214 10.1017/S0954579401002012
    1. Bedell W., Kaszkin-Bettag M. (2010). Coherence and health care cost—RCA actuarial study: a cost-effectiveness cohort study. Altern. Ther. Health Med. 16, 26–31
    1. Bernardi L., Gabutti A., Porta C., Spicuzza L. (2001). Slow breathing reduces chemoreflex response to hypoxia and hypercapnia, and increases baroreflex sensitivity. J. Hypertens. 19, 2221–2229 10.1097/00004872-200112000-00016
    1. Bernardi L., Valle F., Coco M., Calciati A., Sleight P. (1996). Physical activity influences heart rate variability and very-low-frequency components in Holter electrocardiograms. Cardiovasc. Res. 32, 234–237 10.1016/0008-6363(96)00081-8
    1. Berntson G. G., Bigger J. T., Jr., Eckberg D. L., Grossman P., Kaufmann P. G., Malik M., et al. (1997). Heart rate variability: origins, methods, and interpretive caveats. Psychophysiology 34, 623–648 10.1111/j.1469-8986.1997.tb02140.x
    1. Berntson G. G., Cacioppo J. T. (1999). Heart rate variability: a neuroscientific perspective for further studies. Card. Electrophysiol. Rev. 3, 279–282 10.1023/A:1009920002142
    1. Berntson G. G., Norman G. J., Hawley L. C., Cacioppo J. T. (2008). Cardiac autonomic balance versus regulatory capacity. Psychophysiology 45, 643–652 10.1111/j.1469-8986.2008.00652
    1. Berntson G. G., Quigley K. S., Lozano D. (2007). Cardiovascular psychophysiology, in Handbook of Psychophysiology, eds Cacioppo J. T., Tassinary L. G., Berntson G. G. (New York, NY: Cambridge University Press; ), 182–210
    1. Berry M. E., Chapple I. T., Ginsberg J. P., Gleichauf K. J., Meyer J. A., Nagpal M. L. (2014). Non-pharmacological intervention for chronic pain in veterans: a pilot study of heart rate variability biofeedback. Glob. Adv. Health Med. 3, 28–33 10.7453/gahmj.2013.075
    1. Bigger J. T., Jr., Fleiss J. L., Steinman R. C., Rolnitzky L. M., Kleiger R. E., Rottman J. N. (1992). Frequency domain measures of heart period variability and mortality after myocardial infarction. Circulation 85, 164–171 10.1161/01.CIR.85.1.164
    1. Billman G. E. (2013). The LF/HF ratio does not accurately measure cardiac sympatho-vagal balance. Front. Physiol. 4:26 10.3389/fphys.2013.00026
    1. Bonaduce D., Petretta M., Morgano G., Villari B., Binachi V., Conforti G., et al. (1994). Left ventricular remodelling in the year after myocardial infarction: an echocardiographic, haemodynamic, and radionuclide angiographic study. Coron. Artery Dis. 5, 155–162 10.1097/00019501-199402000-00009
    1. Brown T. E., Beightol L. A., Koh J., Eckberg D. L. (1993). Important influence of respiration on human R-R interval power spectra is largely ignored. J. Appl. Physiol. (1985) 75, 2310–2317
    1. Cameron O. G. (2002). Visceral Sensory Neuroscience: Interoception. New York, NY: Oxford University Press
    1. Cantin M., Genest J. (1985). The heart, an endocrine gland. Ann. Endocrinol. 46, 219–228
    1. Cantin M., Genest J. (1986). The heart as an endocrine gland. Clin. Invest. Med. 9, 319–327
    1. Carney R. M., Blumenthal J. A., Stein P. K., Watkins L., Catellier D., Berkman L. F., et al. (2001). Depression, heart rate variability, and acute myocardial infarction. Circulation 104, 2024–2028 10.1161/hc4201.097834
    1. Carney R. M., Freedland K. E., Stein P. K., Miller G. E., Steinmeyer B., Rich M. W., et al. (2007). Heart rate variability and markers of inflammation and coagulation in depressed patients with coronary heart disease. J. Psychosom. Res. 62, 463–467 10.1016/j.jpsychores.2006.12.004
    1. Cerutti S., Bianchi A. M., Mainardi L. T. (1995). Spectral analysis of the heart rate variability signal, in Heart Rate Variability, eds Malik M., Camm A. J. (Armonk, NY: Futura Publishing Company, Inc.), 63–74
    1. Cheng Z., Powley T. L., Schwaber J. S., Doyle F. J., 3rd. (1997). Vagal afferent innervation of the atria of the rat heart reconstructed with confocal microscopy. J. Comp. Neurol. 381, 1–17
    1. Claydon V. E., Krassioukov A. V. (2008). Clinical correlates of frequency analyses of cardiovascular control after spinal cord injury. Am. J. Physiol. Heart Circ. Physiol. 294, H668–H678 10.1152/ajpheart.00869.2007
    1. Cohen H., Benjamin J. (2006). Power spectrum analysis and cardiovascular morbidity in anxiety disorders. Auton. Neurosci. 128, 1–8 10.1016/j.autneu.2005.06.007
    1. Davis A. M., Natelson B. H. (1993). Brain-heart interactions. The neurocardiology of arrhythmia and sudden cardiac death. Tex. Heart Inst. J. 20, 158–169
    1. De Lartique G. (2014). Putative roles of neuropeptides in vagal afferent signaling. Physiol. Behav. S0031-9384, 145–150 10.1016/j.physbeh.2014.03.011
    1. deBoer R. W., Karemaker J. M., Strackee J. (1987). Hemodynamic fluctuations and baroreflex sensitivity in humans: a beat-to-beat model. Am. J. Physiol. 253, H680–H689
    1. DeGiorgio C. M., Miller P., Meymandi S., Chin A., Epps J., Gordon S., et al. (2010). RMSSD, a measure of vagus-mediated heart rate variability, is associated with risk factors for SUDEP: the SUDEP-7 Inventory. Epilepsy Behav. 19, 78–81 10.1016/j.yebeh.2010.06.011
    1. Dekker J. M., Schouten E. G., Klootwijk P., Pool J., Swenne C. A., Kromhout D. (1997). Heart rate variability from short electrocardiographic recordings predicts mortality from all causes in middle-aged and elderly men. The Zutphen Study. Am. J. Epidemiol. 145, 899–908 10.1093/oxfordjournals.aje.a009049
    1. Dietz J. R. (2005). Mechanisms of atrial natriuretic peptide secretion from the atrium. Cardiovasc. Res. 68, 8–17 10.1016/j.cardiores.2005.06.008
    1. Eckberg D. L. (1997). Sympathovagal balance: a critical appraisal. Circulation 96, 3224–3232 10.1161/01.CIR.96.9.3224
    1. Eckberg D. L., Eckberg M. J. (1982). Human sinus node responses to repetitive, ramped carotid baroreceptor stimuli. Am. J. Physiol. 242, H638–H644
    1. Elliot W. J., Izzo J. L., Jr., White W. B., Rosing D. R., Snyder C. S., Alter A., et al. (2004). Graded blood pressure reduction in hypertensive outpatients associated with use of a device to assist with slow breathing. J. Clin. Hypertens. 6, 553–561 10.1111/j.1524-6175.2004.03553.x
    1. Ewing D. J., Campbell I. W., Clarke B. F. (1976). Mortality in diabetic autonomic neuropathy. Lancet 1, 601–603 10.1016/S0140-6736(76)90413-X
    1. Forman E. M., Herbert J. D., Moitra E., Yeomans P. D., Geller P. A. (2007). A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression. Behav. Modif. 31, 772–799 10.1177/0145445507302202
    1. Friedman B. H. (2007). An autonomic flexibility-neurovisceral integration model of anxiety and cardiac vagal tone. Biol. Psychol. 74, 185–199 10.1016/j.biopsycho.2005.08.009
    1. Gevirtz R. (2013). The promise of heart rate variability biofeedback: evidence-based applications. Biofeedback 41, 110–120 10.5298/1081-5937-41.3.01
    1. Giardino N. D., Chan L., Borson S. (2004). Combined heart rate variability and pulse oximetry biofeedback for chronic obstructive pulmonary disease: a feasibility study. Appl. Psychophysiol. Biofeedback 29, 121–133 10.1023/B:APBI.0000026638.64386.89
    1. Giardino N. D., Lehrer P. M., Edelberg R. (2002). Comparison of finger plethysmograph to ECG in the measurement of heart rate variability. Psychophysiology 39, 246–253 10.1111/1469-8986.3920246
    1. Ginsberg J. P., Berry M. E., Powell D. A. (2010). Cardiac coherence and posttraumatic stress disorder in combat veterans. Altern. Ther. Health Med. 16, 52–60
    1. Groves D. A., Brown V. J. (2005). Vagal nerve stimulation: a review of its applications and potential mechanisms that mediate its clinical effects. Neurosci. Biobehav. Rev. 29, 493–500 10.1016/j.neubiorev.2005.01.004
    1. Gutkowska J., Jankowski M., Mukaddam-Daher S., McCann S. M. (2000). Oxytocin is a cardiovascular hormone. Braz. J. Med. Biol. Res. 33, 625–633 10.1590/S0100-879X2000000600003
    1. Hadase M., Azuma A., Zen K., Asada S., Kawasaki T., Kamitani T., et al. (2004). Very low frequency power of heart rate variability is a powerful predictor of clinical prognosis in patients with congestive heart failure. Circ. J. 68, 343–347 10.1253/circj.68.343
    1. Hainsworth R. (1995). The control and physiological importance of heart rate, in Heart Rate Variability, eds Malik M., Camm A. J. (Armonk, NY: Futura Publishing Company, Inc.), 3–19
    1. Heathers J. A. (2012). Sympathovagal balance from heart rate variability: an obituary. Exp. Physiol. 97, 556 10.1113/expphysiol.2011.063867
    1. Hirsch J. A., Bishop B. (1981). Respiratory sinus arrhythmia in humans: how breathing pattern modulates heart rate. Am. J. Physiol. 241, H620–H629
    1. Hirsch J. A., Bishop B. (1996). Role of parasympathetic (vagal) cardiac control in elevated heart rates of smokers. Addict. Biol. 1, 405–413 10.1080/1355621961000125026
    1. Hon E. H., Lee S. T. (1963). Electronic evaluation of the fetal heart rate. VIII. patterns preceding fetal death, further observations. Am. J. Obstet. Gynecol. 87, 814–826
    1. Huang M. H., Friend D. S., Sunday M. E., Singh K., Haley K., Austen K. F., et al. (1996). An intrinsic adrenergic system in mammalian heart. J. Clin. Invest. 98, 1298–1303 10.1172/JCI118916
    1. Huikuri H. V., Niemelä M. J., Ojala S., Rantala A., Ikäheimo M. J., Airaksinen K. E. (1994). Circadian rhythms of frequency domain measures of heart rate variability in healthy subjects and patients with coronary artery disease. Effects of arousal and upright posture. Circulation 90, 121–126 10.1161/01.CIR.90.1.121
    1. Jan B. U., Coyle S. M., Oikawa L. O., Lu S.-E., Calvano S. E., Lehrer P. M., et al. (2009). Influence of acute epinephrine infusion on endotoxin-induced parameters of heart rate variability: a randomized controlled trial. Ann. Surg. 249, 750–756 10.1097/SLA.0b013e3181a40193
    1. Jäncke L., Mérillat S., Liem F., Hänggi J. (2014). Brain size, sex, and the aging brain. Hum. Brain Mapp. [Epub ahead of print]. 10.1002/hbm.22619
    1. Kazuma N., Otsuka K., Matuoska I., Murata M. (1997). Heart rate variability during 24 hours in asthmatic children. Chronobiol. Int. 14, 597–606 10.3109/07420529709001450
    1. Kember G. C., Fenton G. A., Armour J. A., Kalyaniwalla N. (2001). Competition model for aperiodic stochastic resonance in a Fitzhugh-Nagumo model of cardiac sensory neurons. Phys. Rev. E Stat. Nonlin. Soft Matter Phys. 63:041911 10.1103/PhysRevE.63.041911
    1. Kember G. C., Fenton G. A., Collier K., Armour J. A. (2000). Aperiodic stochastic resonance in a hysteretic population of cardiac neurons. Phys. Rev. E Stat. Phys. Plasmas Fluids Relat. Interdiscip. Topics 61, 1816–1824 10.1103/PhysRevE.61.1816
    1. Keyl C., Schneider A., Dambacher M., Bernardi L. (1985). Time delay of vagally mediated cardiac baroreflex response varies with autonomic cardiovascular control. J. Appl. Physiol. 2001, 283–289
    1. Kleiger R. E., Miller J. P., Bigger J. T., Jr., Moss A. J. (1987). Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am. J. Cardiol. 59, 256–262 10.1016/0002-9149(87)90795-8
    1. Kleiger R. E., Stein P. K., Bigger J. T., Jr. (2005). Heart rate variability: measurement and clinical utility. Ann. Noninvasive Electrocardiol. 10, 88–101 10.1111/j.1542-474X.2005.10101.x
    1. Kosel M., Schlaepfer T. E. (2003). Beyond the treatment of epilepsy: new applications of vagus nerve stimulation in psychiatry. CNS Spectr. 8, 515–521
    1. Kukanova B., Mravec B. (2006). Complex intracardiac nervous system. Bratisl. Lek. Listy 107, 45–51
    1. Kuusela T. (2013). Methodological aspects of heart rate variability analysis, in Heart Rate Variability (HRV) Signal Analysis: Clinical Applications, eds Kamath M. V., Watanabe M. A., Upton A. R. M. (Boca Raton, FL: CRC Press; ), 10–42
    1. Lacey B. C., Lacey J. I. (1974). Studies of heart rate and other bodily processes in sensorimotor behavior, in Cardiovascular Psychophysiology, eds Obrist P. A., Black A. H., Brener J., DiCara L. V. (Chicago, IL: Aldine Publishing Company; ), 538–564
    1. Lacey J. I. (1967). Somatic response patterning and stress: some revisions of activation theory, in Psychological Stress: Issues and Research, eds Appley M. H., Trumbull R. (New York, NY: Appleton-Century-Crofts; ), 14–142
    1. Lacey J. I., Lacey B. C. (1970). Some autonomic-central nervous system interrelationships, in Physiological Correlates of Emotion, ed Black P. (New York, NY: Academic Press; ), 205–228
    1. Lampert R., Bremner J. D., Su S., Miller A., Lee F., Cheema F., et al. (2008). Decreased heart rate variability is associated with higher levels of inflammation in middle-aged men. Am. Heart J. 156, 759.e1–759.e7 10.1016/j.ahj.2008.07.009
    1. Lane R. D., Reiman E. M., Ahern G. L., Thayer J. F. (2001). Activity in the medial prefrontal cortex correlates with vagal component of heart rate variability. Brain Cogn. 47, 97–100
    1. Lehrer P., Karavidas M. K., Lu S. E., Coyle S. M., Oikawa L. O., Macor M., et al. (2010). Voluntarily produced increases in heart rate variability modulate autonomic effects of endotoxin induced systemic inflammation: an exploratory study. Appl. Psychophysiol. Biofeedback 35, 303–315 10.1007/s10484-010-9139-5
    1. Lehrer P., Vaschillo B., Zucker T., Graves J., Katsamanis M., Aviles M., et al. (2013). Protocol for heart rate variability biofeedback training. Biofeedback 41, 98–109 10.5298/1081-5937-41.3.08
    1. Lehrer P., Vaschillo E., Trost Z., France C. R. (2009). Effects of rhythmical muscle tension at 0.1Hz on cardiovascular resonance and the baroreflex. Biol. Psychol. 81, 24–30 10.1016/j.biopsycho.2009.01.003
    1. Lehrer P. M. (2007). Biofeedback training to increase heart rate variability, in Principles and Practice of Stress Management, eds Lehrer P. M., Woolfolk R. L., Sime W. E. (New York, NY: The Guilford Press; ), 227–248
    1. Lehrer P. M. (2013). How does heart rate variability biofeedback work? Resonance, the baroreflex, and other mechanisms. Biofeedback 41, 26–31 10.5298/1081-5937-41.1.02
    1. Lehrer P. M., Karavidas M. K., Lu S. E., Feldman J., Kranitz L., Abraham S., et al. (2008). Psychological treatment of comorbid asthma and panic disorder: a pilot study. J. Anxiety Disord. 22, 671–683 10.1016/j.janxdis.2007.07.001
    1. Lehrer P. M., Vaschillo E., Vaschillo B., Lu S. E., Eckberg D. L., Edelberg R., et al. (2003). Heart rate variability biofeedback increases baroreflex gain and peak expiratory flow. Psychosom. Med. 65, 796–805 10.1097/01.PSY.0000089200.81962.19
    1. Lehrer P. M., Vaschillo E., Vaschillo B., Lu S. E., Scardella A., Siddique M., et al. (2004). Biofeedback treatment for asthma. Chest 126, 352–361 10.1378/chest.126.2.352
    1. Lombardi F., Sandrone G., Mortara A., Torzillo D., La Rovere M. T., Signorini M. G., et al. (1996). Linear and nonlinear dynamics of heart rate variability after acute myocardial infarction with normal and reduced left ventricular ejection fraction. Am J. Cardiol. 77, 1283–1288 10.1016/S0002-9149(96)00193-2
    1. MacKinnon S., Gevirtz R., McCraty R., Brown M. (2013). Utilizing heartbeat evoked potentials to identify cardiac regulation of vagal afferents during emotion and resonant breathing. Appl. Psychophysiol. Biofeedback 38, 241–255 10.1007/s10484-013-9226-5
    1. Malliani A. (1995). Association of heart rate variability components with physiological regulatory mechanisms, in Heart Rate Variability, eds Malik M., Camm A. J. (Armonk, NY: Futura Publishing Company, Inc.), 173–188
    1. Malliani A., Pagani M., Lombardi F., Cerutti S. (1991). Cardiovascular neural regulation explored in the frequency domain. Circulation 84, 482–492 10.1161/01.CIR.84.2.482
    1. Marieb E. N., Hoehn K. (2013). Human Anatomy and Physiology. San Francisco, CA: Pearson
    1. Mateo J., Torres A., Rieta J. J. (2011). An efficient method for ectopic beats cancellation based on radial basis function. Conf. Proc. IEEE Med. Biol. Soc. 2011, 6947–6950 10.1109/IEMBS.2011.6091756
    1. Mauskop A. (2005). Vagus nerve stimulation relieves chronic refractory migraine and cluster headaches. Cephalalgia 25, 82–86 10.1111/j.1468-2982.2005.00611.x
    1. McCraty R. (2011). Coherence: bridging personal, social and global health. Act. Nerve. Super. 53, 85–102
    1. McCraty R., Atkinson M. (2012). Resilience training program reduces physiological and psychological stress in police officers. Global Adv. Health Med. 1, 44–66 10.7453/gahmj.2012.1.5.013
    1. McCraty R., Atkinson M., Bradley R. T. (2004). Electrophysiological evidence of intuition: part 1. The surprising role of the heart. J. Altern. Complement. Med. 10, 133–143 10.1089/107555304322849057
    1. McCraty R., Atkinson M., Tomasino D. (2003). Impact of a workplace stress reduction program on blood pressure and emotional health in hypertensive employees. J. Altern. Complement. Med. 9, 355–369 10.1089/107555303765551589
    1. McCraty R., Atkinson M., Tomasino D., Bradley R. T. (2009). The coherent heart: heart-brain interactions, psychophysiological coherence, and the emergence of system-wide order. Integral Rev. 5, 10–115
    1. McCraty R., Childre D. (2010). Coherence: bridging personal, social, and global health. Altern. Ther. Health Med. 16, 10–24
    1. Montoya P., Schandry R., Müller A. (1993). Heartbeat evoked potentials (HEP): topography and influence of cardiac awareness and focus of attention. Electroencephalogr. Clin. Neurophysiol. 88, 163–172 10.1016/0168-5597(93)90001-6
    1. Mukoyama M., Nakao K., Hosoda K., Suga S., Saito Y., Ogawa Y., et al. (1991). Brain natriuretic peptide as a novel cardiac hormone in humans. Evidence for an exquisite dual natriuretic peptide system, atrial natriuretic peptide and brain natriuretic peptide. J. Clin. Invest. 87, 1402–1412 10.1172/JCI115146
    1. Nunan D., Sandercock G. R., Brodie D. A. (2010). A quantitative systematic review of normal values for short-term heart rate variability in healthy adults. Pacing Clin. Electrophysiol. 33, 1407–1417 10.1111/j.1540-8159.2010.02841.x
    1. Ogletree-Hughes M. L., Stull L. B., Sweet W. E., Smedira N. G., McCarty P. M., Moravec C. S. (2001). Mechanical unloading restores beta-adrenergic responsiveness and reverses receptor downregulation in the failing human heart. Circulation 104, 881–886 10.1161/hc3301.094911
    1. Olshansky B., Sabbah H. N., Hauptman P. J., Colucci W. S. (2008). Parasympathetic nervous system and heart failure: pathophysiology and potential implications for therapy. Circulation 118, 863–871 10.1161/CIRCULATIONAHA.107.760405
    1. Opthof T. (2000). The normal range and determinants of the intrinsic heart rate in man. Cardiovasc. Res. 45, 177–184 10.1016/S0008-6363(99)00322-3
    1. Otsuka K., Cornelissen G., Halberg F. (1997). Age, gender and fractal scaling in heart rate variability. Clin. Sci. (Lond.) 93, 299–308
    1. Otzenberger H., Gronfier C., Simon C., Charloux A., Ehrhart J., Piquard F., et al. (1998). Dynamic heart rate variability: a tool for exploring sympathovagal balance continuously during sleep in men. Am. J. Physiol. 275(3 pt 2), H946–H950
    1. Pagani M., Lombardi F., Guzzetti S., Rimoldi O., Furlan R., Pizzinelli P., et al. (1986). Power spectral analysis of heart rate and arterial pressure variabilities as a marker of sympatho-vagal interactions in man and conscious dog. Circ. Res. 59, 178–193 10.1161/01.RES.59.2.178
    1. Pagani M., Lombardi F., Guzzetti S., Sandrone G., Rimoldi O., Malfatto G., et al. (1984). Power spectral density of heart rate variability as an index of symptho-vagal interactions in normal and hypertensive subjects. J. Hypertens. Suppl. 2, 383–385
    1. Pentillä J., Helminen A., Jarti T., Kuusela T., Huikuri H. V., Tulppo M. P., et al. (2001). Time domain, geometrical and frequency domain analysis of cardiac vagal outflow: effects of various respiratory patterns. Clin. Phys. 21, 365–376 10.1046/j.1365-2281.2001.00337.x
    1. Pomeranz B., Macaulay R. J., Caudill M. A., Kutz I., Adam D., Gordon D., et al. (1985). Assessment of autonomic function in humans by heart rate spectral analysis. Am. J. Physiol. 248, H151–H153
    1. Porges S. W. (2007). The polyvagal perspective. Biol. Psychol. 74, 116–143 10.1016/j.biopsycho.2006.06.009
    1. Porges S. W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-regulation (Norton Series on Interpersonal Neurobiology). New York, NY: W. W. Norton & Company
    1. Rahman F., Pechnik S., Gross D., Sewell L., Goldstein D. S. (2011). Low frequency power of heart rate variability reflects baroreflex function, not cardiac sympathetic innervation. Clin. Auton. Res. 21, 133–141 10.1007/s10286-010-0098-y
    1. Randall D. C., Evans J. M., Billman G. E., Ordway G. A., Knapp C. F. (1981). Neural, hormonal and intrinsic mechanisms of cardiac control during acute coronary occlusion in the intact dog. J. Auton. Nerv. Syst. 3, 87–99 10.1016/0165-1838(81)90032-1
    1. Reineke A. (2008). The effects of heart rate variability biofeedback in reducing blood pressure for the treatment of essential hypertension. Diss. Abstr. Int. Sec. B Sci. Eng. 68, 4880
    1. Reyes Del Paso G. A., Langewitz W., Mulder L. J. M., Van Roon A., Duschek S. (2013). The utility of low frequency heart rate variability as an index of sympathetic cardiac tone: a review with emphasis on a reanalysis of previous studies. Psychophysiology 50, 477–487 10.1111/psyp.12027
    1. Schafer A., Vagedes J. (2013). How accurate is pulse rate variability as an estimate of heart rate variability? A review on studies comparing photoplethysmographic technology with an electrocardiogram. Int. J. Cardiol. 166, 15–29 10.1016/j.ijcard.2012.03.119
    1. Schandry R., Montoya P. (1996). Event-related brain potentials and the processing of cardiac activity. Biol. Psychol. 42, 72–85 10.1016/0301-0511(95)05147-3
    1. Schipke J. D., Arnold G., Pelzer M. (1999). Effect of respiration rate on short-term heart rate variability. J. Clin. Basic Cardiol. 2, 92–95
    1. Schmidt H., Müller-Werdan U., Hoffmann T., Francis D. P., Piepoli M. F., Rauchhaus M., et al. (2005). Autonomic dysfunction predicts mortality in patients with multiple organ dysfunction syndrome of different age groups. Crit. Care Med. 33, 1994–2002 10.1097/01.CCM.0000178181.91250.99
    1. Schroeder E. B., Liao D., Chambless L. E., Prineas R. J., Evans G. W., Heiss G. (2003). Hypertension, blood pressure, and heart rate variability. Hypertension 42, 1106–1111 10.1161/01.HYP.0000100444.71069.73
    1. Shaffer F., Venner J. (2013). Heart rate variability anatomy and physiology. Biofeedback 41, 13–25 10.5298/1081-5937-41.1.05
    1. Shah A. J., Lampert R., Goldberg J., Veledar E., Bremner J. D., Vaccarino V. (2013). Posttraumatic stress disorder and impaired autonomic modulation in male twins. Biol. Psychiatry 73, 1103–1110 10.1016/j.biopsych.2013.01.019
    1. Singh R. B., Cornélissen G., Weydahl A., Schwartzkopff O., Katinas G., Otsuka K., et al. (2003). Circadian heart rate and blood pressure variability considered for research and patient care. Int. J. Cardiol. 87, 9–28 discussion: 29–30. 10.1016/S0167-5273(02)00308-X
    1. Sowder E., Gevirtz R., Shapiro W., Ebert C. (2010). Restoration of vagal tone: a possible mechanism for functional abdominal pain. Appl. Psychophysiol. Biofeedback 35, 199–206 10.1007/s10484-010-9128-8
    1. Stampfer H. G. (1998). The relationship between psychiatric illness and the circadian pattern of heart rate. Aust. N.Z. J. Psychiatry 32, 187–198 10.3109/00048679809062728
    1. Stampfer H. G., Dimmitt S. B. (2013). Variations in circadian heart rate in psychiatric disorders: theoretical and practical implications. Chronophysiol. Ther. 3, 41–50 10.2147/CPT.S43623
    1. Svensson T. H., Thorén P. (1979). Brain adrenergic neurons in the locus coeruleus: inhibition by blood volume load through vagal afferents. Brain Res. 172, 174–178 10.1016/0006-8993(79)90908-9
    1. Task Force. (1996). Heart rate variability: standards of measurement, physiological interpretation, and clinical use. Circulation 93, 1043–1065 10.1161/01.CIR.93.5.1043
    1. Taylor S. E. (2006). Tend and befriend biobehavioral bases of affiliation under stress. Curr. Dir. Psychol. Sci. 15, 273–277 10.1111/j.1467-8721.2006.00451.x
    1. Thayer J. F., Ahs F., Fredrikson M., Sollers J. J., III., Wagner T. D. (2012). A meta-analysis of heart rate variability and neuroimaging studies: implications for heart rate variability as a marker of stress and health. Neurosci. Biobehav. Rev. 36, 747–756 10.1016/j.neubiorev.2011.11.009
    1. Thayer J. F., Hansen A. L., Saus-Rose E., Johnsen B. H. (2009). Heart rate variability, prefrontal neural function, and cognitive performance: the neurovisceral integration perspective on self-regulation, adaptation, and health. Ann. Behav. Med. 37, 141–153 10.1007/s12160-009-9101-z
    1. Thayer J. F., Lane R. D. (2000). A model of neurovisceral integration in emotion regulation and dysregulation. J. Affect. Disord. 61, 201–216 10.1016/S0165-0327(00)00338-4
    1. Thayer J. F., Yamamoto S. S., Brosschot J. F. (2010). The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors. Int. J. Cardiol. 141, 122–131 10.1016/j.ijcard.2009.09.543
    1. Theorell T., Liljeholm-Johansson Y., Björk H., Ericson M. (2007). Saliva testosterone and heart rate variability in the professional symphony orchestra after “public faintings” of an orchestra member. Psychoneuroendocrinology 32, 660–668 10.1016/j.psyneuen.2007.04.006
    1. Tiller W. A., McCraty R., Atkinson M. (1996). Cardiac coherence: a new, noninvasive measure of autonomic nervous system order. Altern. Ther. Health Med. 2, 52–65
    1. Tortora G. J., Derrickson B. H. (2014). Principles of Anatomy and Physiology. Hoboken, NJ: John Wiley & Sons, Inc
    1. Tracey K. J. (2007). Physiology and immunology of the cholinergic anti-inflammatory pathway. J. Clin. Invest. 117, 289–296 10.1172/JCI30555
    1. Tsuji H., Larson M. G., Venditti F. J., Jr., Manders E. S., Evans J. C., Feldman C. L., et al. (1996). Impact of reduced heart rate variability on risk for cardiac events. The Framingham Heart Study. Circulation 94, 2850–2855 10.1161/01.CIR.94.11.2850
    1. Tsuji H., Venditti F. J., Jr., Manders E. S., Evans J. C., Larson M. G., Feldman C. L., et al. (1994). Reduced heart rate variability and mortality risk in an elderly cohort. The Framingham Heart Study. Circulation 90, 878–883 10.1161/01.CIR.90.2.878
    1. Umetani K., Singer D. H., McCraty R., Atkinson M. (1998). Twenty-four hour time domain heart rate variability and heart rate: relations to age and gender over nine decades. J. Am. Coll. Cardiol. 31, 593–601 10.1016/S0735-1097(97)00554-8
    1. Vaschillo E., Lehrer P., Rishe N., Konstantinov M. (2002). Heart rate variability biofeedback as a method for assessing baroreflex function: a preliminary study of resonance in the cardiovascular system. Appl. Psychophysiol. Biofeedback 27, 1–27 10.1023/A:1014587304314
    1. Vaschillo E., Vaschillo B., Lehrer P. (2004). Heartbeat synchronizes with respiratory rhythm only under specific circumstances. Chest 126, 1385–1387 10.1378/chest.126.4.1385-a
    1. Vaschillo E. G., Vaschillo B., Pandina R. J., Bates M. E. (2011). Resonances in the cardiovascular system caused by rhythmical muscle tension. Psychophysiology 48, 927–936 10.1111/j.1469-8986.2010.01156.x
    1. Velden M., Wölk C. (1987). Depicting cardiac activity over real time: a proposal for standardization. J. Psychophysiol. 1, 173–175
    1. Verkerk A. O., Remme C. A., Schumacher C. A., Scicluna B. P., Wolswinkel R., de Jonge B., et al. (2012). Functional Nav1.8 channels in intracardiac neurons: the link between SCN10A and cardiac electrophysiology. Circ. Res. 111, 333–343 10.1161/CIRCRESAHA.112.274035
    1. Wölk C., Velden M. (1989). Revision of the baroreceptor hypothesis on the basis of the new cardiac cycle effect, in Psychobiology: Issues and Applications, eds Bond N. W., Siddle D. (North-Holland: Elsevier Science Publishers; ), 371–379
    1. Yasuma F., Hayano J. (2004). Respiratory sinus arrhythmia: why does the heartbeat synchronize with respiratory rhythm? Chest 125, 683–690 10.1378/chest.125.2.683
    1. Zhang J. X., Harper R. M., Frysinger R. C. (1986). Respiratory modulation of neuronal discharge in the central nucleus of the amygdala during sleep and waking states. Exp. Neurol. 91, 193–207 10.1016/0014-4886(86)90037-3

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel