Key result
Heart rate fragmentation indices strongly correlate with vagally mediated HRV during autonomic challenges.
Why the study?
It remains unclear whether heart rate fragmentation reflects intrinsic sinoatrial dynamics independent of autonomic influences or is shaped by cardiac autonomic balance in healthy individuals.
Do physiological shifts in autonomic modulation (via tilt test and controlled breathing) affect heart rate fragmentation indices in healthy adults?
Observational (n=20)
Do physiological shifts in autonomic modulation (via tilt test and controlled breathing) affect heart rate fragmentation indices in healthy adults?
Effect estimate: r = 0.74
Heart rate fragmentation is significantly influenced by autonomic activity and cardiorespiratory coupling in healthy individuals, challenging the view that it is a purely intrinsic, autonomic-independent marker.
HRF may reflect autonomic modulation in healthy adults; challenges sinoatrial independence hypothesis but remains hypothesis-generating.
Introduction Heart rate fragmentation (HRF) quantifies rapid beat-to-beat irregularity in cardiac intervals and has emerged as a predictor of adverse cardiovascular outcomes. While standard heart rate variability (HRV) indices primarily reflect autonomic modulation, HRF has been proposed to capture intrinsic sinoatrial node dynamics largely independent of autonomic influences. However, the extent to which HRF is shaped by cardiac autonomic balance in healthy individuals remains unclear. We examined whether HRF responds to controlled physiological shifts in autonomic modulation and investigated its relationship with established HRV indices. Methods Twenty healthy adults (29 ± 4 years) underwent two complementary autonomic challenges: a graded head-up tilt test to progressively increase sympathetic drive and attenuate vagal cardiac modulation, and controlled breathing at 0.1 Hz to selectively enhance cardiac parasympathetic activity in a slow frequency band. HRF indices were quantified along with standard time- and frequency-domain HRV parameters and symbolic dynamic analysis. Associations between HRF and HRV indices were assessed using Spearman’s rank correlation coefficients. Results Graded tilt produced a progressive reduction in HRF indices that closely paralleled decreases in vagally mediated HRV parameters. HRF indices, particularly the percentage of inflection points (PIP), showed strong correlations with the 2UV symbolic pattern (r = 0.74). Controlled breathing enhanced parasympathetic modulation and elicited a shift of respiratory oscillations from high- to low-frequency spectral bands. All variations corresponding to high frequencies (HF, 2UV%, PIP, and other indices related to more fragmented rhythms) decreased in favor of an increase in low-frequency variations (LF/HF, 0V%, 2LV%). Discussion Rather than providing information purely about cardiovascular autonomic control, these findings indicate that, in healthy subjects, both HRV and HRF indices are strongly influenced by cardiorespiratory coupling. Collectively, these results provide the first evidence that HRF in healthy individuals is significantly influenced by autonomic activity, especially parasympathetic modulation. These findings challenge the prevailing view of HRF as a purely intrinsic, autonomic-independent marker, indicating that it is also influenced by the respiratory frequency range. Taken together, these observations indicate that HRF reflects autonomic mechanisms under physiological conditions. Whether this relationship is preserved or altered under pathological conditions remains to be established and warrants investigation in future studies.
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Silva et al. (2026) conducted an observational in Healthy (n=20). Graded head-up tilt test and controlled breathing was evaluated on Heart rate fragmentation (HRF) indices and their relationship with HRV indices (r = 0.74). In healthy adults, heart rate fragmentation indices responded to autonomic challenges and strongly correlated with vagally mediated heart rate variability parameters (r = 0.74 for PIP and 2UV).
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