Regarding the article "D. Ostojic at all: Acute effects of muscular counterpulsation therapy on cardiac output and safety in patients with chronic heart failure."

It is disappointing that the 2012 publication by German authors, based on research conducted in Bad Oeynhausen on patients suffering from CHF (NYHA II-III) using the "m.pulse" device of the 5th generation MCP (CARDIOLA AG), revealed a consistent occurrence of tachycardia during the MCP procedure. The authors cannot explain the cause of this tachycardia. Simultaneously, they draw a parallel with physical exercises, suggesting the possible occurrence of transient tachycardia due to the heart's load during muscle-related physical activity.

In the opinion of the MCP method's author, there are two apparent reasons: device malfunctions and an inadequate research protocol.

A. The instability of the recent device model's functioning, as described earlier, and the failure to synchronize it with the appropriate phase of the cardiac cycle contribute to increased afterload, leading to tachycardia, and so on. If pronounced muscle contractions are present, activating the muscle-venous pump and intensifying preload, the symptoms of heart overload become even more pronounced. In this context, comparing the results with physical exercise is logical, but please note that such procedures have nothing to do with MCP. 

B. Incorrectly designed stimulation protocol. Provided that the "K-factor" (i.e., delay from the R-wave) is correctly chosen and adequate synchronization is achieved, excessive activation of the muscle-venous pump with heightened preload during pronounced muscle contractions could be the cause of tachycardia (as should have occurred during the study, according to the stimulation methodology described in the "Principles of MCP" section).

Thus, the article doesn't explicitly state it but clearly demonstrates that for CHF, achieving myocardial unloading with MCP requires more than just proper synchronization in time. It is essential to select an appropriate level of muscle activity to maintain the delicate equilibrium between oxygen demand and delivery on one hand and to avoid increasing preload on the other.  

Consequently, the level of electrical irritation/stimulation and the strength of muscle contractions used in the protocol of this study initially predicted an analogy to physical exercise. The conclusion drawn from the analysis of the results should sound like this: "Pronounced muscle contractions during an MCP session in patients with

CHF, instead of unloading, lead to increased cardiac load, resulting in transient tachycardia," as well as hypertension, discomfort, and heaviness in the heart area. For this patient category, especially during the first week of MCP treatment, only threshold or even sub-threshold stimulation modes should be used, activating muscles no more than within the range of "-50% - 0%" of maximum tetanic tension (MTT).

Well, a negative result is also a result to learn from and not to repeat in the future!

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In any case, I need to express my deep gratitude towards German doctors, whose article helped to reveal malfunctions of “m.pulse”.