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According to classical concepts of physiologic control, healthy systems are self-regulated to reduce variability and maintain physiologic constancy. Contrary to the common believe, however, the output of a wide variety of systems, such as the normal human heartbeat, fluctuates in a fractal manner, even under resting conditions. In contrast, for subjects at high risk of sudden death (including those with heart failure), fractal organization breaks down. Application of fractal analysis may provide new approaches to assessing cardiac risk and forecasting sudden cardiac death.