Patterns of beat-to-beat heart rate variability in advanced heart failure

Mary A. Woo, William G. Stevenson, Debra K. Moser, Robert B. Trelease, Ronald M. Harper

Research output: Contribution to journalArticlepeer-review

341 Scopus citations


Diminished heart rate variability is associated with high sympathetic tone and an increased mortality rate in heart failure cases. We constructed Poincaré plots of each sinus R-R interval plotted against the subsequent R-R interval from 24-hour Holter recordings of 24 healthy subjects (control group) and 24 patients with heart failure. Every subject in the control group had a comet-shaped Poincaré plot resulting from an increase in beat-to-beat dispersion as heart rate slowed. No patient with heart failure had this comet-shaped pattern. Instead, three distinctive patterns were identified: (1) a torpedo-shaped pattern resulting from low R-R interval dispersion over the entire range of heart rates, (2) a fanshaped pattern resulting from restriction of overall R-R interval ranges with enhanced dispersion, and (3) complex patterns with clusters of points characteristic of stepwise changes in R-R intervals. Poincaré pattern could not be predicted from standard deviations of R-R intervals. This first use of Poincaré plots in heart rate variability analysis reveals a complexity not readily perceived from standard deviation information. Further study is warranted to determine if this method will allow refined assessment of cardiac-autonomic integrity in heart failure, which could help identify patients at highest risk for sudden death.

Original languageEnglish
Pages (from-to)704-710
Number of pages7
JournalAmerican Heart Journal
Issue number3
StatePublished - Mar 1992

Bibliographical note

Funding Information:
Division of Cardiology, the Department Institute, University in part by a grant by the Audrienne UCLA School of Medicine, of Anatomy and Cell Biology, of California, Los Angeles. from the Gamma Tau Chapter H. Moseley Scholar Award,

Copyright 2014 Elsevier B.V., All rights reserved.

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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