Heart Rate Variability Analysis in Patients Who Have Bradycardia Presenting to the Emergency Department with Chest Pain

Jeffrey Tadashi Sakamoto, Nan Liu, Zhi Xiong Koh, Dagang Guo, Micah Liam Arthur Heldeweg, Janson Cheng Ji Ng, Marcus Eng Hock Ong

Research output: Contribution to journalArticleAcademicpeer-review


BACKGROUND: Heart rate variability (HRV) is a noninvasive method to measure the function of the autonomic nervous system. It has been used to risk stratify patients with undifferentiated chest pain in the emergency department (ED). However, bradycardia can have a modifying effect on HRV.

OBJECTIVE: In this study, we aimed to determine how bradycardia affected HRV analysis in patients who presented with chest pain to the ED.

METHODS: Adult patients presenting to the ED at Singapore General Hospital with chest pain were included in the study. Patients with non-sinus rhythm on electrocardiogram (ECG) were excluded. HRV parameters, including time domain, frequency domain, and nonlinear variables, were analyzed from a 5-min ECG segment. Occurrence of a major adverse cardiac event ([MACE], e.g., acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, or mortality) within 30 days of presentation to the ED was also recorded.

RESULTS: A total of 797 patients were included for analysis with 248 patients (31.1%) with 30-day MACE and 135 patients with bradycardia (16.9%). Compared to non-bradycardic patients, bradycardic patients had significant differences in all HRV parameters suggesting an increased parasympathetic component. Among non-bradycardic patients, comparing those who did and did not have 30-day MACE, there were significant differences predominantly in time domain variables, suggesting decreased HRV. In bradycardic patients, the same analysis revealed significant differences in predominantly frequency-domain variables suggesting decreased parasympathetic input.

CONCLUSIONS: Chest pain patients with bradycardia have increased HRV compared to those without bradycardia. This may have important implications on HRV modeling strategies for risk stratification of bradycardic and non-bradycardic chest pain patients.

Original languageEnglish
Pages (from-to)273-280
Number of pages8
JournalJournal of Emergency Medicine
Issue number3
Publication statusPublished - Mar 2018


  • Acute Coronary Syndrome/complications
  • Adult
  • Aged
  • Bradycardia/etiology
  • Chest Pain/etiology
  • Electrocardiography/methods
  • Emergency Service, Hospital/organization & administration
  • Female
  • Heart Rate/physiology
  • Humans
  • Male
  • Middle Aged
  • Monitoring, Physiologic/methods
  • Singapore
  • Time Factors

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