Electromechanical coupling in the cardiac myocyte; stretch-arrhythmia feedback

The macroscopic hallmarks of the normal heartbeat are rapid onset of contraction and rapid relaxation and an inotropic response to both increased end diastolic volume and increased heart rate. At the microscopic level, the calcium ion (Ca 2+ ) plays a crucial role in normal cardiac contraction. This paper reviews the cycle of Ca 2+ fluxes during the normal heartbeat, which underlie the coupling between excitation and contraction (ECC) and permit a highly synchronized action of cardiac sarcomeres. Length dependence of the response of the regulatory sarcomeric proteins mediates the Frank–Starling Law of the heart. However, Ca 2+ transport may go astray in heart disease and both jeopardize the exquisite mechanism of systole and diastole and triggering arrhythmias. The interplay between weakened and strong segments in nonuniform cardiac muscle may further lead to mechanoelectric feedback—or reverse excitation contraction coupling (RECC) mediating an early diastolic Ca 2+ transient caused by the rapid force decrease during the relaxation phase. These rapid force changes in nonuniform muscle may cause arrhythmogenic Ca 2+ waves to propagate by activation of neighbouring SR by diffusing Ca 2+ ions.