ORIGINAL RESEARCH article
Front. Physiol.
Sec. Cardiac Electrophysiology
Volume 16 - 2025 | doi: 10.3389/fphys.2025.1630032
Pulse Rate Variability is Not the Same as Heart Rate Variability: Findings from a Large, Diverse Clinical Population Study
Provisionally accepted
Allen B Kantrowitz1Kfir Ben-David2,3Michael Morris4,5Leonard A Temme6
Harrison Wittels7Michael J Wishon7
Samantha McDonald7,8*Eric J Renaghan9
Luis A Feigenbaum10S Howard Wittels11,12,13,7- 1Department of Neuro Surgery, Mount Sinai Medical Center, Miami Beach, United States
- 2Department of General Surgery, College of Medicine, University of Florida, Gainesville, United States
- 3Department of Surgery, Mount Sinai Medical Center, Miami Beach, United States
- 4Department of Pulmonology, Brooke Army Medical Center, Houston, United States
- 5San Antonio Uniformed Services Health Education Consortium, Uniformed Services University, San Antonio, United States
- 6United States Army Aeromedical Research Laboratory, Fort Novosel, United States
- 7Tiger Tech Solutions, Inc, Miami, United States
- 8School of Kinesiology and Recreation, Illinois State University, Normal, United States
- 9Department of Athletics, Sports Science, Miller School of Medicine, University of Miami, Miami, United States
- 10Deparment of Physical Therapy, Miller School of Medicine, University of Miami, Miami, United States
- 11Department of Anesthesiology, Mount Sinai Medical Center, Miami, United States
- 12Department of Anesthesiology, Wertheim School of Medicine, Florida International University, Miami, United States
- 13Miami Beach Anesthesiology Associates, Miami, United States
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Scientists and consumer products are increasingly employing light-based photoplethysmography (PPG) instead of electrocardiography (ECG) assuming it accurately quantifies heart rate variability (HRV). Recent studies, however, have demonstrated that pulse rate variability (PRV) derived from PPG is not equivalent to HRV-derived from ECG. This study investigated the agreement between PPG-PRV and ECG-HRV in a beat-to-beat analysis in 931 adults recruited from a tertiary academic medical center in the southeastern United States. Participants wore two (chest and bicep) Warfighter Monitor™ devices (Tiger Tech Solutions, Inc). Heart rate (HR), pulse rate (PR) and three time-domain indices for PPG-PRV and ECG-HRV were measured. ECG-derived RR and noise-filtered NN intervals were extracted to compute HR, SDNN (standard deviation of NN intervals), rMSSD (root mean square of successive differences), and pNN50 (percentage of successive NN intervals differing by >50 ms). PPG-derived pulse-wave peaks were detected to calculate corresponding PR/PRV metrics. Pearson correlation, Bland-Altman, and one-way ANOVA analyses assessed linear association, bias, and mean differences across select chronic diseases. Significant disagreement and differences were observed between ECG-HRV and PPG-PRV (p<0.001 for all).
Keywords: cardiovascular, Heart rate variability, Pulse rate variability, Pulse wave, wearable, Technology, Autonomic Nervous System, electrocardiogram
Received: 16 May 2025; Accepted: 26 Jun 2025.
Copyright: © 2025 Kantrowitz, Ben-David, Morris, Temme, Wittels, Wishon, McDonald, Renaghan, Feigenbaum and Wittels. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Samantha McDonald, School of Kinesiology and Recreation, Illinois State University, Normal, United States
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.