A view of the cardiac rhythm control: Intrinsic regulation

Regulation of the cardiac rhythm is intricate and occurs at least at two major levels, intrinsic and extrinsic. In turn, each of these levels can be divided into several sublevels. The factors regulating the cardiac activity eventually affect the duration of spontaneous diastolic depolarization of pacemaker myocytes of the sinoatrial node and, to a far lesser extent, the conduction velocity in the conduction system of the heart. Intrinsic regulation of the heart rate (HR) includes the myogenic sublevel and the sublevels of cell-to-cell communication, the cardiac nervous system, and humoral factors produced within the heart. Myogenic regulation is considered to be the first sublevel in control of the cardiac function. The available data suggest myogenic regulation only for the contractility of the myocardium. The cell-to-cell regulation sublevel involves two principal mechanisms. One depends on the heterogeneous structure of the sinoatrial node and within-node shifts of the dominant pacemaker, which is a group of cells that determine the HR and govern all other cells of the sinoatrial node. The other mechanism is based on the effects of peptides produced by cardiomyocytes and endothelial cells on pacemaker cells of the sinoatrial node. Regulatory peptides are also produced by the cardiac nervous system, which includes sensory and effector autonomic fibers, represents the cardiac part of the metasympathetic system, and forms intramural ganglia. In addition to modulating the HR, these peptides affect the contractility, microcirculation, coronary blood flow, preload, and afterload. Currently available data demonstrate that the autonomic nervous system is far more intricate than believed earlier. Using various neuropeptides, this system provides for fine adjustment of the cell functions, subject to its immediate control.Translated from Fiziologiya Cheloveka, Vol. 31, No. 2, 2005, pp. 116–129.Original Russian Text Copyright © 2005 by Nozdrachev, Kotelnikov, Mazhara, Naumov.Deceased.