Indicators of heart rate variability in children with acute bronchopulmonary diseases




children, respiratory diseases, ECG monitoring, heart rate variability, autonomic balance


Holter electrocardiogram (ECG) monitoring is a modern method for diagnosing of the cardiovascular system state and allows for a deeper study of the risks of comorbidity on its part in respiratory diseases. Among a significant number of indicators of the method, heart rate variability stands out as a marker of the balance between the activity of the sympathetic and parasympathetic parts of the autonomic nervous system. In children with acute respiratory diseases, it is important and poorly studied assessment of the autonomic balance and the degree of influence of this pathology on the autonomic functions of the heart.

Aim - to analyze the features of heart rhythm variability and its relationship with autonomic innervation in children with acute respiratory diseases.

Materials and methods. 50 children (18 children with acute bronchitis, 12 children with pneumonia and 20 clinically healthy individuals of the control group) were examined. The functional state of the cardiovascular system was determined using office blood pressure measurement and Holter ECG monitoring. The ECG was recorded for 5 minutes, followed by an assessment of heart rate variability.

Results. The paper analyzes the indicators of heart rate variability, which have a clear physiological basis, such as the measure of the central tendency of the RR interval, indicators of variance, heart rhythm concentration, and the level of parasympathetic effects on the heart rhythm. A significant difference between the data obtained in the experimental groups relative to the control group was established, and a shift in the autonomic balance towards sympathetic tone was revealed, and in children with acute bronchitis these changes are greater than in patients with pneumonia.

Conclusions. Assessment of the autonomic nervous system balance using Holter ECG monitoring with a short recording is a modern method for diagnosing its disorders. In respiratory diseases, the most sensitive indicators are heart rhythm concentration, the level of parasympathetic effects on heart rhythm and spectral indicators of heart rate variability.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.


Babik IV, Niankovskyi SL. (2014). Osoblyvosti variabelnosti sertsevoho rytmu u ditei shkilnoho viku iz pozashpytalnoiu pnevmoniieiu. Naukovyi visnyk Uzhhorodskoho universytetu, seriia «Medytsyna». 2 (50): 176-179.

Baumert M, Porta A, Vos MA et al. (2016). QT interval variability in body surface ECG: measurement, physiological basis, and clinical value: position statement and consensus guidance endorsed by the European Heart Rhythm Association jointly with the ESC working group on cardiac cellular electrophysiology. Europace. 18(6): 925-944.; PMid:26823389 PMCid:PMC4905605

Begic Z, Begic E, Mesihovic-Dinarevic S et al. (2016). The use of continuous electrocardiographic Holter monitoring in pediatric cardiology. Acta Inform Med. 24(4): 253-256.; PMid:27708487 PMCid:PMC5037995

Blanc E, Chaize G, Fievez S et al. (2021). The impact of comorbidities and their stacking on short- and long-term prognosis of patients with community-acquired pneumonia. BMC Infect Dis. 21: 949.; PMid:34521380 PMCid:PMC8442401

Bobkowski W, Stefaniak ME, Krauze T et al. (2017). Measures of heart rate variability in 24-h ECGs depend on age but not gender of healthy children. Front Physiol. 8: 311.; PMid:28572771 PMCid:PMC5435822

Cruz-Ávila H, Vallejo M, Martínez-García M et al. (2020). Comorbidity Networks in cardiovascular diseases. Front Physiol. 11: 1009.; PMid:32982776 PMCid:PMC7485389

De Freitas Coelho P, Barbosa RRB, Dos Santos Lugao R et al. (2022). Heart rate variability, exercise capacity and levels of daily physical activity in children and adolescents with mild-to-moderate cystic fibrosis. Hong Kong Physiother J. 42(1): 5-14.; PMid:35782696 PMCid:PMC9244599

Dikecligil GN, Mujica-Parodi LR. (2010). Ambulatory and challenge-associated heart rate variability measures predict cardiac responses to real-world acute emotional stress. Biol Psychiatry. 67(12): 1185-90.; PMid:20299007 PMCid:PMC2882500

Feshchenko YuI, Iashyna LO, Polianska MO et al. (2022). Comorbidity in patients with bronchial asthma and risks of severe COVID-19 (a literature review). Аsthma and allergy. 3: 41-49.

Gąsior JS, Młyńczak M, Rosoł M et al. (2023). Validity of the Pneumonitor for RR intervals acquisition for short-term heart rate variability analysis extended with respiratory data in pediatric cardiac patients. Kardiol Pol. 81(5): 491-500.; PMid:36929303

Haakana P, Holopainen K, Nätkynmäki A et al. (2023). The effect of paired associative stimulation with a high-intensity cortical component and a high-frequency peripheral component on heart rate and heart rate variability in healthy subjects. Front Rehabil Sci. 4: 1200958.; PMid:37565182 PMCid:PMC10410150

Hegazy RA, Lotfy WN. (2007). The value of Holter monitoring in the assessment of pediatric patients. Indian Pacing Electrophysiol J. 7(4): 204-214. URL:; PMCID: PMC2018732.

Izhaki N, Perek S, Agbaria M. (2022). Ultrashort heart rate variability for early risk stratification in pneumonia patients: preliminary analysis. Isr Med Assoc J. 24(11): 741-746. URL:

Jarrin DC, McGrath JJ, Poirier P et al. (2015). Short-term heart rate variability in a population-based sample of 10-year-old children. Pediatr Cardiol. 36(1): 41-48.; PMid:25056158 PMCid:PMC4457514

Kokkinaki T, Markodimitraki M, Giannakakis G et al. (2023). Comparing full and pre-term neonates' heart rate variability in rest condition and during spontaneous interactions with their parents at home. Healthcare (Basel). 11(5): 672.; PMid:36900677 PMCid:PMC10000654

Laborde S, Mosley E, Thayer J. (2017). Heart rate variability and cardiac vagal tone in psychophysiological research - recommendations for experiment planning, data analysis, and data reporting. Front Psychol. 8: 213.; PMid:28265249 PMCid:PMC5316555

Lackner HK, Eglmaier MTW, Hackl-Wimmer S et al. (2020). How to use heart rate variability: quantification of vagal activity in toddlers and adults in long-term ECG. Sensors (Basel). 20(20): 5959.; PMid:33096844 PMCid:PMC7589813

Mitiuriaeva IO, Kryvonos YuM, Labunka OV. (2016). Osoblyvosti pokaznykiv variabelnosti rytmu sertsia u ditei, khvorykh na tsukrovyi diabet 1 typu v zalezhnosti vid tryvalosti zakhvoriuvannia. Mizhnarodnyi zhurnal pediatrii, akusherstva ta hinekolohii. 9(2): 46-49. URL:

Mooren FC, Böckelmann I, Waranski M et al. (2023). Autonomic dysregulation in long-term patients suffering from Post-COVID-19 Syndrome assessed by heart rate variability. Sci Rep. 13(1): 15814.; PMid:37739977 PMCid:PMC10516975

Richter J, Pietzner A, Koenig J et al. (2021). Vagal control of the heart decreases during increasing imminence of interoceptive threat in patients with panic disorder and agoraphobia. Sci Rep. 11(1): 7960.; PMid:33846417 PMCid:PMC8041829

Schiwe D, Vendrusculo FM, Becker NA et al. (2023). Impact of asthma on heart rate variability in children and adolescents: Systematic review and meta-analysis. Pediatr Pulmonol. 58(5): 1310-1321.; PMid:36719098

Shaffer F, Ginsberg JP. (2017). An overview of heart rate variability metrics and norms. Front Public Health. 5: 258.; PMid:29034226 PMCid:PMC5624990

Sookan T, Mckune AJ. (2012). Heart rate variability in physically active individuals: reliability and gender characteristics. Cardiovasc J Afr. 23(2): 67-72. URL:; PMCID: PMC3721889.

Zalas D, Bobkowski W, Piskorski J et al. (2023). Heart rate asymmetry in healthy children. J Clin Med. 12(3): 1194.; PMid:36769841 PMCid:PMC9918166





Original articles