Heart rate variability (HRV) is a measure of the balance between sympathetic mediators of heart rate that is the effect of
epinephrine and norepinephrine released from sympathetic nerve fibres acting on the sino-atrial and atrio-ventricular
nodes which increase the rate of cardiac contraction and facilitate conduction at the atrio-ventricular node and
parasympathetic mediators of heart rate that is the influence of acetylcholine released by the parasympathetic nerve
fibres acting on the sino-atrial and atrio-ventricular nodes leading to a decrease in the heart rate and a slowing of
conduction at the atrio-ventricular node. Sympathetic mediators appear to exert their influence over longer time periods
and are reflected in the low frequency power(LFP) of the HRV spectrum (between 0.04Hz and 0.15 Hz).Vagal mediators
exert their influence more quickly on the heart and principally affect the high frequency power (HFP) of the HRV
spectrum (between 0.15Hz and 0.4 Hz). Thus at any point in time the LFP:HFP ratio is a proxy for the sympatho- vagal
balance. Thus HRV is a valuable tool to investigate the sympathetic and parasympathetic function of the autonomic
nervous system. Study of HRV enhance our understanding of physiological phenomenon, the actions of medications and
disease mechanisms but large scale prospective studies are needed to determine the sensitivity, specificity and predictive
values of heart rate variability regarding death or morbidity in cardiac and non-cardiac patients