From Electrical Morphology to Physiological Dynamics: Lessons From ECG Adoption for the Clinical Integration of Heart Rate Variability

作者：Puglisi JL, Sodhi G, Carmargo SM, Goroso DG · 发表于：European journal of clinical investigation · 年份：2026 · DOI：10.1111/eci.70249 · 被引用次数：12 · 研究领域：Electrocardiography、Heart Rate、Arrhythmias, Cardiac、Humans、Artificial Intelligence、Digital Health、Large Language Models、Wearable Electronic Devices

BACKGROUND: Heart rate variability (HRV) has remained a relatively finite and niche tool in cardiology despite decades of research supporting its physiological and clinical relevance. This limited adoption may resemble the early history of electrocardiography (ECG), which was initially regarded by many physicians as a laboratory instrument rather than a routine clinical tool. The delayed acceptance of ECG reflected technological limitations, cultural resistance and the need for clinicians to master unfamiliar concepts derived from physics and electrophysiology. HRV faces comparable barriers today. Although derived from ECG RR intervals, HRV requires interpretation of time-domain, frequency-domain, geometric and nonlinear indices that may appear mathematically complex and distant from conventional bedside reasoning. AIMS: We argue that HRV should not be viewed as a replacement for ECG, but as an extension of ECG from electrical morphology to physiological dynamics. MATERIALS AND METHODS: Lessons from ECG history were examined and compared with the current state of HRV adoption in clinical practice. The complementary diagnostic roles of ECG morphology and HRV analysis were considered, together with the potential contribution of wearable sensors, remote monitoring, artificial intelligence and large language models to facilitate HRV interpretation, education and clinical integration. RESULTS: Whereas conventional ECG morphology identifies arrhythmias, conduction disturbances, ...