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ORIGINAL RESEARCH article

Front. Physiol.

Sec. Cardiac Electrophysiology

This article is part of the Research TopicExercise Prescription, Physiological Mechanisms, and Exercise Safety in Patients with Cardiac Devices and ArrhythmiasView all 6 articles

Short-term HRV Metrics as a Method for Intraoperative Assessment of Cardiac Parasympathetic Response to Rapid Atrial Pacing

Provisionally accepted
Przemysław SkoczyńskiPrzemysław Skoczyński1,2Bruno HrymniakBruno Hrymniak1,3*Bartosz SkoniecznyBartosz Skonieczny1Krystian JosiakKrystian Josiak1Bartosz BielBartosz Biel1Antoni WileczekAntoni Wileczek4Katarzyna CzarneckaKatarzyna Czarnecka5Sebastian StecSebastian Stec6,7Waldemar BanasiakWaldemar Banasiak1,3Dorota ZyśkoDorota Zyśko1,3Dariusz JagielskiDariusz Jagielski1,3
  • 14th Military Hospital of Wroclaw, Wroclaw, Poland
  • 2Uniwersytet Medyczny im Piastow Slaskich we Wroclawiu, Wrocław, Poland
  • 3Politechnika Wroclawska, Wrocław, Poland
  • 4Panaceum- Med, Sanok, Poland
  • 5American Heart of Poland, Dąbrowa Górnicza, Poland
  • 6Panstwowy Instytut Medyczny Ministerstwa Spraw Wewnetrznych i Administracji, Warsaw, Poland
  • 7ELMedica, EP-Network, Skarżysko-Kamienna, Poland

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Rapid atrial pacing induces a measurable parasympathetic response, expressed as increases in RMSSD and ΔPP. These heart rate variability parameters can be assessed intraoperatively, offering a simple and repeatable method to quantify vagal modulation of the sinus node during electrophysiological procedures. The reproducibility of this response within a single intervention supports its potential utility for monitoring autonomic effects in real time. This approach may be particularly valuable for evaluating the impact of ablation strategies such as pulmonary vein isolation or cardioneuroablation. However, it reflects sinus node activity only and requires further validation.

Keywords: Autonomic Nervous System, Cardioneuroablation (CNA), electrophysiological study (EPS), HRV (heart rate variability), Parasympathetic Nervous System

Received: 25 Nov 2025; Accepted: 23 Jan 2026.

Copyright: © 2026 Skoczyński, Hrymniak, Skonieczny, Josiak, Biel, Wileczek, Czarnecka, Stec, Banasiak, Zyśko and Jagielski. 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: Bruno Hrymniak

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.

Supplementary Material