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From Electrical Morphology to Physiological Dynamics: Lessons From ECG Adoption for the Clinical Integration of Heart
José Luis Puglisi1, Gurpreet Sodhi1, Samuel Minucci Carmargo2
1College of Medicine, California Northstate University, Elk Grove, California, USA.
European Journal of Clinical Investigation
|August 6, 2026
Summary
Heart rate variability (HRV) offers insights into autonomic function, extending electrocardiography (ECG) beyond electrical patterns. Overcoming adoption barriers through technology and education is key for its clinical integration.
Area of Science:
- Cardiology
- Physiology
- Medical Technology
Background:
- Heart rate variability (HRV) remains underutilized in cardiology despite proven relevance.
- Similar to early electrocardiography (ECG) adoption, HRV faces technological and educational hurdles.
- HRV analysis involves complex metrics, posing challenges for routine clinical interpretation.
Purpose of the Study:
- To position HRV as a dynamic extension of ECG, not a replacement.
- To explore historical parallels between ECG and HRV adoption.
- To identify strategies for enhancing HRV's clinical integration.
Main Methods:
- Comparative analysis of ECG history and current HRV adoption.
- Examination of complementary roles of ECG morphology and HRV.
- Assessment of emerging technologies like wearables and AI for HRV interpretation.
Main Results:
- ECG identifies electrical abnormalities; HRV reveals autonomic and systemic regulation.
- Wearable sensors, AI, and remote monitoring can mitigate HRV adoption barriers.
- AI can bridge the gap by translating complex HRV data into clinical insights.
Conclusions:
- HRV adoption faces challenges similar to ECG's early history.
- Standardization, education, and cultural acceptance are crucial for HRV integration.
- Technological advancements offer opportunities to overcome current limitations.
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