On pathophysiological aspects of electrotherapy of the heart

With progress in Electrotherapy of the heart, used nowadays also in heart failure (HF) patients, the problem of physiological character of therapy and prevention of iatrogenic effects become even more challenging. Clinical research is aimed on physiological rate adaptation and myocardium excitation pattern at pacing, and thus on minimizing the disturbances of the cardiovascular system (CVS) regulation loops. Criteria for physiological therapy could be the haemodynamic improvement avoiding the stress characteristic non-specific amplification of neurohumoral regulation (NHR). Rate adaptive pacing accounting for Inotropic myocardium function, regulated by the Autonomous nervous system directly via the β-adrenergic network, could decrease the myocardium adrenergic modulation for patients’ benefit, also in HF. Along with the neurohumoral factors, being the main cause of HF syndrome, different inflammation cytokines play their key role by modulating the CVS functions. Inflammation in one or another form manifests itself practically in all cardiac pathologies and heart arrhythmias independent of their localization. It has rather common pathogenic and morphological pattern, mediated by different system markers, including Endotoxin as well. Appropriately, the biological markers, participating in the NHR processes, of specific and non-specific adaptation of the body to metabolic demand, are significant to determine the physiological character of the therapy, also in the heart pacing. Further research is based on the knowledge of both the CVS regulation loops and the mechanisms of specific and non-specific adaptation of the body to different factors, i.e. the physical load and the psycho emotional stress.