# Equal heartbeat intervals and their effects on the nonlinearity of permutation-based time irreversibility in heart rate

## TL;DR

This study investigates how equal heartbeat intervals influence permutation-based time irreversibility measures in heart rate analysis, revealing their potential as biomarkers for cardiac health and aging-related changes.

## Contribution

We demonstrate the significance of equal heartbeat intervals in nonlinear heart rate analysis and introduce an equality-based approach for more accurate nonlinearity detection.

## Key findings

- CHF shows around 20% equal heartbeat intervals
- Equalities discriminate heart conditions at short data lengths
- Equality-based measures better capture nonlinear heart rate behaviors

## Abstract

The association of equal heartbeat intervals with cardiac conditions and the effect of the equality on permutation-based time irreversibility are investigated in this paper. We measure the distributions of equal heartbeat intervals under three conditions, namely congestive heart failure (CHF), healthy young and elderly, whose time irreversibility of heartbeats is detected by measuring the probabilistic difference between permutations instead of raw vectors. We demonstrate that heartbeats contain high rates of equal states, particularly the CHF with around 20% equalities, and the distributions of equal values discriminate the heartbeats at very short data length. The CHF have more equal values than the healthy young (p<1.47*10^{-15}) and elderly (p<2.48*10^{-11}), and the healthy young have less equalities than the elderly (p<3.16*10^{-4}). Time irreversibility considering equal values is promising to extract nonlinear behaviors of heartbeats, confirming the decreased nonlinear complexity of the diseased and aging heart rates, while that involving no equality leads to erroneous nonlinearity detection. In our contribution, we highlight the pathological or physiological information contained by the distribution of equal heartbeat intervals that might contribute to develop relevant biomarkers in the area of heart analysis, and demonstrate the effectiveness of equality-based time irreversibility in the nonlinearity detection of heartbeats.