The mechanism of action of<unk>  has been subject to continuous research since its initial discovery. Based on animal testing and experiments on human myocardial tissue obtained by biopsies, essential parts of the mechanism of action have been identified. According to current understanding (as of February 2015), the mechanism of action of<unk>  may be summarized in the following manner: The signals applied during the electrical non-excitatory state of the<unk>  muscle cells (the absolute refractory period) cause an increase in myocyte calcium in the cytosol during systole. This increases the muscle contraction strength. Additionally, within minutes, cell metabolism and gene expression, which are typically abnormal in heart failure, improve towards their normal state. This beneficial effect occurs initially only in the area adjacent to the electrodes, but with time also spreads to remote areas of the<unk>  muscle.<unk>  therefore restores the structure and function of damaged cells back towards their normal state. In some cases, disease-related changes in the ventricular heart structure can be partially reversed by<unk>  through a process known as reverse remodeling of the heart.
Cardiac contractility modulation
Vascular recruitment
Isolytic muscle contraction
Neural facilitation
Local blood flow regulation
Vasodilation
Vasoconstriction
Cardioprotection