The LF/HF ratio does not accurately measure cardiac sympatho-vagal balance
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OPINION article Front. Physiol., 20 February 2013Sec. Clinical and Translational Physiology Volume 4 - 2013 | https://doi.org/10.3389/fphys.2013.00026
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Sympathetic and parasympathetic activity are not reciprocal, but interact in a loosely coupled fashion.
“It should be noted, though, that sympathetic and parasympathetic activity are not reciprocal, but interact in a loosely coupled fashion (e.g. Billman, 2013; de Geus et al., 2019).”
From Trauma-related dissociation and the autonomic nervous system: a systematic literature review of psychophysiological correlates of dissociative experiencing in PTSD patients (2022) · cites this paper as Billman, 2013
In the section on LF/HF and sympatho-vagal balance, Billman describes complex, non-linear interactions and examples where sympathetic and parasympathetic activity do not change reciprocally. But the paper also says small arterial-pressure changes typically provoke reciprocal changes, so the claim's unqualified statement that the activities 'are not reciprocal' overstates the source. (LLM, conf=0.85)
Experimental — accuracy not yet measuredUnder ordinary circumstances, decreases in high-frequency heart rate variability indicate decreased parasympathetic and increased sympathetic activation.
“Under ordinary circumstances, HF decreases indicate decreased parasympathetic and increased sympathetic activation [36, 48, 49]”
From The Influence of Buddhist Meditation Traditions on the Autonomic System and Attention (2015) · cites this paper as [36]
In the paper’s main text (page not provided), Billman reports a strong association between HF power and cardiac parasympathetic activity, supporting the first part of the claim. But the paper does not establish that an HF decrease ordinarily indicates increased sympathetic activation; it cautions that sympathetic and parasympathetic activity do not always change reciprocally and that HF power has other influences. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThere is now a consensus that the precise physiological underpinning of the LF/HF ratio is unclear, thus lowering its predictive value.
“Hence, there is now a consensus to say that the precise physiological underpinning is unclear, thus lowering its predictive value.”
From Heart Rate Variability and Cardiac Vagal Tone in Psychophysiological Research – Recommendations for Experiment Planning, Data Analysis, and Data Reporting (2017) · cites this paper as Billman, 2013
In the paper’s concluding discussion (page unavailable), Billman says the physiological basis of LF/HF cannot be determined with certainty and that the ratio cannot accurately quantify cardiac sympatho-vagal balance. The paper does not establish a consensus or assess the ratio’s predictive value; it also says the ratio remains widely accepted despite its limitations. (LLM, conf=0.85)
Experimental — accuracy not yet measured
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- Authors
- Billman, G. E.
- Affiliations
- The Ohio State University (US)
- Corresponding author
- Billman, George E.
- Venue
- Frontiers in Physiology
- Publisher
- Frontiers Media SA
- Published
- 2013
- Volume
- 4
- Pages
- 26-26
- ISSN
- 1664-042X (ISSN-L)
- PMC
- PMC3576706
- OpenAlex
- W2107161633
- Cited by
- 1,401
- References
- 65
- Citations by year
- 2026: 177 · 2025: 140 · 2024: 122 · 2023: 123 · 2022: 134 · 2021: 130 · 2020: 115 · 2019: 107 · 2018: 121 · 2017: 98 · 2016: 54 · 2015: 36 · 2014: 29 · 2013: 14
- FWCI
- 30.11
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Frontiers in Physiology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Life Sciences › Neuroscience › Neurology › Vagus Nerve Stimulation Research
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Keywords
- LF/HF ratio, heart rate variability, autonomic nervous system
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