Reproducibility of heart rate variability characteristics measured on random 10-second ECG using joint symbolic dynamics

In this paper we employed joint symbolic dynamics (JSD) approach to study reproducibility of heart rate variability characteristics measured on 2 randomly selected 10-second segments within 3-minute resting orthogonal ECG in 170 healthy participants. First, the ECG R-peaks were detected using parabolic fitting. Second, the respiratory signal was derived from orthogonal ECG X-lead using QRS slopes. Third, time series of R-R intervals and respiratory phases (calculated using Hilbert transform), were transformed into tertiary symbol vectors based on their successive changes and words of length '3' were formed. Bland-Altman analysis was used to assess the agreement between measured log-transformed JSD characteristics of HRV, and their reproducibility. Traditional HRV measures such as RR' interval changes showed a very high reproducibility. However, agreement between two 10-second JSD indices of HRV was low. Interestingly, a significant decrease in low-high alterations of HRV dynamics measured using JSD was observed when respiratory phase transition intervals were excluded (10s: 4.7±9.4 vs. 24.8±21.0%, p<0.0001; 3min: 9.8±8.1 vs. 24.8±12.3%, p<0.0001).