Effect of age, sex and BMI on resting ECG intervals and their variabilities in healthy adults

ObjectiveWhile there are numerous reports on heart rate and its variabilities, a detailed analysis of the component intervals for healthy adults in well controlled condition is lacking. This study analyzes the effect of age, sex, and Body Mass Index (BMI) on nine resting electrocardiogram (ECG) intervals and their intra-individual variabilities in healthy adults under the same testing environment. MethodsUsing the "Autonomic Aging" dataset, ECG recordings from 1,121 healthy volunteers (ages 18-92) were processed. The study employed a specialized segmentation algorithm to identify key ECG markers. We analyze statistically how age, BMI, and sex impact the durations and variabilities of nine ECG intervals. ResultsFifty years of age serves as a critical transition age for cardiac aging for all subjects as a whole. Above this age, the active interval, which is the combined atrial and ventricular conduction time, increases three times faster than at a younger age, primarily driven by lengthening of depolarization times. Compared to the opposite sex, older low-BMI males have a longer atrial conduction time, and older low-BMI females have a larger variability in the ventricular conduction time. High BMI increases the heart rate by reducing the length of the idle interval, i.e., the isoelectric segment at the end of a cardiac cycle. The rate increase is more pronounced among older subjects than younger ones. High BMI males start to exhibit an elevated heart rate and larger variability in the atrial conduction time in their 30s. High BMI females start to show a larger variability in the ventricular repolarization time around 50 years old. ConclusionAge, BMI, and sex all have major impacts on the ECG intervals and their variability. A resting heart behaves largely like a pulse width modulation system, with a stable active interval and an adjustable idle interval to meet the varying needs for cardiac output. The durations and variabilities of the active interval, more than those of the RR interval, are indicators of a hearts health condition. A young and healthy heart tends to have a shorter duration and smaller variability in the active interval.