Measurement of heart rate variability by methods based on nonlinear dynamics.

Heart rate (HR) variability has been conventionally analyzed with time and frequency domain methods, which measure the overall magnitude of R-R interval fluctuations around its mean value or the magnitude of fluctuations in some predetermined frequencies. Analysis of HR dynamics by methods based on chaos theory and nonlinear system theory has gained recent interest. This interest is based on observations suggesting that the mechanisms involved in cardiovascular regulation likely interact with each other in a nonlinear way. Furthermore, recent observational studies suggest that some indexes describing nonlinear HR dynamics, such as fractal scaling exponents, may provide more powerful prognostic information than the traditional HR variability indexes. In particular, short-term fractal scaling exponent measured by detrended fluctuation analysis method has been shown to predict fatal cardiovascular events in various populations. Approximate entropy, a nonlinear index of HR dynamics, which describes the complexity of R-R interval behavior, has provided information on the vulnerability to atrial fibrillation. There are many other nonlinear indexes, eg, Lyapunov exponent and correlation dimensions, which also give information on the characteristics of HR dynamics, but their clinical utility is not well established. Although concepts of chaos theory, fractal mathematics, and complexity measures of HR behavior in relation to cardiovascular physiology or various cardiovascular events are still far away from clinical medicine, they are a fruitful area for future research to expand our knowledge concerning the behavior of cardiovascular oscillations in normal healthy conditions as well as in disease states.