Heart rate deceleration capacity as a marker of perioperative risk: identifying relevant patient phenotypes and surgical procedures

Loss of regulation of the autonomic nervous system is found in many diseases from the age of 50 to 60 yr and even more so in older patients. The imbalance is usually manifested by an increase in sympathetic tone, long considered to be the most deleterious element in terms of cardiac rhythmic risk, but also by a reduction in the effectiveness of short-term regulation of the baroreflex arc (partial loss of parasympathetic control). Techniques for analysing this autonomic disorder by analysing heart rate regulation are widely available in outpatient clinics and provide interesting indicators of cardiovascular and cerebrovascular risk. Deceleration capacity of cardiac autonomic control has been identified for its prognostic role in high-risk patients and in the general population. Further research is indicated to assess the value of this marker in anaesthetic risk management by targeting procedures with greater risk of intraoperative and postoperative autonomic dysfunction.