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Review
. 2025 Jul-Aug:91:67-79.
doi: 10.1016/j.pcad.2025.06.003. Epub 2025 Jun 10.

Heart rate variability in patients with cardiovascular diseases

Muhammad Shahzeb Khan  1 , Syed Sarmad Javaid  2 , Robert J Mentz  3 , JoAnn Lindenfeld  4 , Hau-Tieng Wu  5 , Jürgen H Prochaska  6 , Jens Brock Johansen  7 , Philipp S Wild  6 , Dominik Linz  8 , Wilfried Dinh  9 , Marat Fudim  10
Affiliations
Review

Heart rate variability in patients with cardiovascular diseases

Muhammad Shahzeb Khan et al. Prog Cardiovasc Dis. 2025 Jul-Aug.

Abstract

Heart rate variability (HRV) has been reported to predict overall mortality and the risk of cardiovascular disease events in patients, including those with heart failure. However, inconsistent methods of recording and analyzing HRV parameters, along with a lack of randomized data substantiating its clinical efficacy and potential to guide treatment decisions for improved patient outcomes, have limited its use in clinical settings. With the advancements in technologies such as artificial intelligence and machine learning, and emergence of ablation procedures that can alter autonomic function, this article re-explores HRV assessment methods, their potential for clinical application, the issues encountered in using them in clinical research, and potential approaches to studying HRV in the future (Graphical Abstract).

Keywords: Cardiac resynchronization therapy; Cardiovascular events; Heart failure; Heart rate variability.

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Conflict of interest statement

Declaration of competing interest MSK reports fees from Bayer and Boehringer Ingelheim. RJM received research support and honoraria from Abbott, American Regent, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Cytokinetics, Fast BioMedical, Gilead, Innolife, Eli Lilly, Medtronic, Medable, Merck, Novartis, Novo Nordisk, Pharmacosmos, Relypsa, Respicardia, Roche, Sanofi, Vifor, Windtree Therapeutics, and Zoll. JL received research support and honoraria from Abbott, Alleviant, AstraZeneca, Boston Scientific, Cordio, Cytokinetics, CVRx, Edwards Lifesciences, Medtronic, Merck, VWave, Whiteswell. JHP received funding for lecturing by Bayer AG and Boehringer Ingelheim outside the topic of this work. JBJ has relationship with Medtronic – consulting, advisory, speaking and lecture fees. Relationship with BIOTRONIK – consulting, advisory and lecture fees. Relationship with Merit Medical Systems Inc. – consulting, advisory and speaking and lecture fees. PSW reports grants from Bayer AG, non-financial grants from Philips Medical Systems, grants and consulting fees from Boehringer Ingelheim, grants and consulting fees from Novartis Pharma, grants and consulting fees from Sanofi-Aventis, grants, consulting and lecturing fees from Bayer Health Care, grants and consulting fees from Daiichi Sankyo Europe, lecturing fees from Pfizer Pharma, lecturing fees from Bristol Myers Squibb, consulting fees from Astra Zeneca, consulting fees and non-financial support from Diasorin and non-financial support from I.E.M. PSW is principal investigator of the German Center for Cardiovascular Research (DZHK) and DIASyM research core (BMBF DIASyM research core (BMBF 161L0217A). DL received research support and honoraria from AstraZeneca, Bayer, Medtronic, Novo Nordisk, Respicardia, Sanofi, Zoll. WD is a full-time employee of Bayer Pharmaceuticals. MF is supported by American Heart Association Grant 17MCPRP33460225 and NIH T32 Grant 5T32HL007101; and is a consultant for Coridea and Galvani. SSJ and HW have nothing to disclose.

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