Role of editing of R–R intervals in the analysis of heart rate variability

This paper reviews the methods used for editing of the R-R interval time series and how this editing can influence the results of heart rate (HR) variability analyses. Measurement of HR variability from short and long-term electrocardiographic (ECG) recordings is a non-invasive method for evaluating cardiac autonomic regulation. HR variability provides information about the sympathetic-parasympathetic autonomic balance. One important clinical application is the measurement of HR variability in patients suffering from acute myocardial infarction. However, HR variability signals extracted from R-R interval time series from ambulatory ECG recordings often contain different amounts of artifact. These false beats can be either of physiological or technical origin. For instance, technical artifact may result from poorly fastened electrodes or be due to motion of the subject. Ectopic beats and atrial fibrillation are examples of physiological artifact. Since ectopic and other false beats are common in the R-R interval time series, they complicate the reliable analysis of HR variability sometimes making it impossible. In conjunction with the increased usage of HR variability analyses, several studies have confirmed the need for different approaches for handling false beats present in the R-R interval time series. The editing process for the R-R interval time series has become an integral part of these analyses. However, the published literature does not contain detailed reviews of editing methods and their impact on HR variability analyses. Several different editing and HR variability signal pre-processing methods have been introduced and tested for the artifact correction. There are several approaches available, i.e., use of methods involving deletion, interpolation or filtering systems. However, these editing methods can have different effects on HR variability measures. The effects of editing are dependent on the study setting, editing method, parameters used to assess HR variability, type of study population, and the length of R-R interval time series. The purpose of this paper is to summarize these pre-processing methods for HR variability signal, focusing especially on the editing of the R-R interval time series.