Heart rate asymmetry in children: a scoping review
Abstract
Heart rate asymmetry (HRA) is a nonlinear measure reflecting unequal contributions of heart rate decelerations and accelerations to heart rate variability (HRV). This scoping review, conducted in line with the PRISMA extension for Scoping Reviews (PRISMA-ScR) guidelines, aimed to summarize current evidence on HRA in pediatric populations. A systematic search of PubMed, Scopus, Web of Science, Embase, and Google Scholar (2000–2025) identified four eligible studies involving 192 children aged 3–18 years, including healthy individuals and those with attention deficit/hyperactivity disorder (ADHD), depression, or cardiac conditions. All studies were single-center and used electrocardiography (1000 Hz); one used 24-hour Holter monitoring, whereas the others used 5-minute recordings. One study also used a Pneumonitor (250 Hz). HRA was assessed using Porta’s index, Guzik’s index, and Ehlers’ index. Some studies included orthostatic testing. The findings suggest HRA may help detect neurocardiac dysregulation in both healthy children and those with specific diagnoses and may serve as a prognostic tool. Further research is needed to confirm its clinical relevance.