Measurement of the evoked cardiac response: the problem of prestimulus variability

This paper discusses the problem of prestimulus variability in cardiac activity and its implications for the measurement of evoked cardiac responses (ECRs). Two methods which have been proposed to reduce error arising from respiratory sinus arrhythmis (SA) were reviewed critically. The first approach attempts to control only for the error associated with the sampling of the prestimulus level. This is considered inappropriate since it does not take into account the continuation of SA into the poststimulus period. The second approach reviewed was time series analysis which provides an elegant statistical solution of the problem. Unfortunately, the application of time series analysis has not yet been evaluated for adult cardiac data. A third approach which utilizes an adjustment for SA by employing the actual prestimulus values of an SA cycle was proposed. The application of this technique in the case of a pseudostimulus demonstrated that correction for SA results in significantly smaller 'responses' with less variance than does a conventional procedure which does not take prestimulus variability into account.