Sudden Cardiac Death from the Perspective of Nonlinear Dynamics.

There are some reports that sympathetic nerve activity (SNA) shows a characteristic pattern a few hours before the onset of lethal ventricular arrhythmias. If so, it could be possible to predict sudden cardiac death a few hours in advance of its occurrence. Recently, we reported that a previously unidentified V-trough of SNA is a potential precursor of lethal cardiac events by examining 24-hour ambulatory electrocardiograms in which such an event was recorded by chance. In contrast, the chaotic nature of heart rate variability has been noted recently from the viewpoint of nonlinear dynamics. This study models the hemodynamics, consisting of heart rate, SNA, and blood pressure (BP), by modifying a known chaotic electrical circuit, the Chua circuit. A V-trough of the SNA appears when the resistive element between the SNA and BP in the circuit is increased, which corresponds to the impaired regulation of BP by the SNA. This finding is consistent with an acknowledged finding that a depressed baroreflex (a reflex of the BP by SNA) may trigger a lethal arrhythmia. This study indicates that a V-trough of the SNA is a possible precursor of sudden cardiac death on the basis of experimental and clinical findings as well as mathematical modeling.