Redefining respiratory sinus arrhythmia as respiratory heart rate variability: an international Expert Recommendation for terminological clarity

Clément Menuet, INMED, INSERM, Aix-Marseille University, Marseille, France. clement.menuet@inserm.fr.
Alona Ben-Tal, Insightful Modelling, Auckland, New Zealand.
Ambre Linossier, INMED, INSERM, Aix-Marseille University, Marseille, France.
Andrew M. Allen, Department of Anatomy & Physiology, University of Melbourne, Melbourne, Victoria, Australia.
Benedito H. Machado, Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
Davi J. Moraes, Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.
David G. Farmer, Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia.
David J. Paterson, Burdon Sanderson Cardiac Science Centre and BHF Centre of Research Excellence, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK.
David Mendelowitz, Department of Pharmacology and Physiology, George Washington University, Washington, DC, USA.
Edward G. Lakatta, Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, MA, USA.
Edwin W. Taylor, School of Biosciences, University of Birmingham, Birmingham, UK.
Gareth L. Ackland, Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK.
Irving H. Zucker, Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, USA.
James P. Fisher, Manaaki Manawa - The Centre for Heart Research, Department of Physiology, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand.
James S. Schwaber, Department of Pathology, Anatomy, and Cell Biology, Daniel Baugh Institute for Functional Genomics and Computational Biology, Thomas Jefferson University, Philadelphia, PA, USA.
Julia Shanks, Manaaki Manawa - The Centre for Heart Research, Department of Physiology, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand.
Julian F. Paton, Manaaki Manawa - The Centre for Heart Research, Department of Physiology, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand.
Julie Buron, Department of Fundamental Neurosciences, University of Lausanne, Lausanne, Switzerland.
K Michael Spyer, Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology & Pharmacology, University College London, London, UK.
Kalyanam Shivkumar, University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, Los Angeles, CA, USA.
Mathias Dutschmann, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, USA.
Michael J. Joyner, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
Neil Herring, Burdon Sanderson Cardiac Science Centre and BHF Centre of Research Excellence, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK.
Paul Grossman, Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland.
Robin M. McAllen, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria, Australia.
Rohit Ramchandra, Manaaki Manawa - The Centre for Heart Research, Department of Physiology, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand.
Song T. Yao, Department of Anatomy & Physiology, University of Melbourne, Melbourne, Victoria, Australia.
Thomas Ritz, Department of Psychology, Southern Methodist University, Dallas, TX, USA.
Alexander V. Gourine, Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology & Pharmacology, University College London, London, UK.

Document Type

Journal Article

Publication Date

5-6-2025

Journal

Nature reviews. Cardiology

DOI

10.1038/s41569-025-01160-z

Abstract

The variation of heart rate in phase with breathing, known as 'respiratory sinus arrhythmia' (RSA), is a physiological phenomenon present in all air-breathing vertebrates. RSA arises from the interaction of several physiological mechanisms but is primarily mediated by rhythmic changes in cardiac parasympathetic (vagal) activity, increasing heart rate during inspiration and decreasing heart rate during expiration. RSA amplitude is an indicator of autonomic and cardiac health; RSA is diminished or absent in common pathological conditions such as chronic heart failure and hypertension. In this Expert Recommendation, we argue that the term 'RSA', although historically important, is semantically inaccurate and carries misleading pathological connotations, contributing to misunderstanding and misinterpretation of the origin and the physiological importance of the phenomenon. We propose replacing 'RSA' with the term 'respiratory heart rate variability' (RespHRV), which avoids pathological connotations and emphasizes the specific respiratory contribution to heart rate variability. We clarify that RespHRV encompasses respiratory-related heart rate variations in both the low-frequency and high-frequency bands traditionally defined in heart rate variability analysis, and that its amplitude should not be misconstrued as a measure of vagal tone. Adopting the proposed term 'RespHRV' is expected to unify understanding and stimulate further experimental and clinical research into the physiological mechanisms and functional importance of this phenomenon.

Department

Pharmacology and Physiology

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