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The complexity of the cardiac rhythm is demonstrated to exhibit self-affine multifractal variability. The dynamics of heartbeat interval time series was analyzed by application of the multifractal formalism based on the Cramèr theory of large deviations. The continuous multifractal large deviation spectrum uncovers the nonlinear fractal properties in the dynamics of heart rate and presents a useful diagnostic framework for discrimination and classification of patients with cardiac disease, e.g., congestive heart failure. The characteristic multifractal pattern in heart transplant recipients or chronic heart disease highlights the importance of neuroautonomic control mechanisms regulating the fractal dynamics of the cardiac rhythm.