What is Bowditch effect in the heart?

Henry Pickering Bowditch described a frequency dependent inotropic response of the heart muscle way back in 1871. It is an increase in force of contraction of myocardial cells with each heartbeat with an increase in heart rate. This stepwise increase in force of contraction is also called staircase phenomenon and Treppe phenomenon, for obvious reasons. It has a basis in the calcium handling of cardiac myocytes. A negative Bowditch effect may be noted in heart failure while the positive Bowditch effect is seen in healthy heart [2].

Sarcoplasmic endoplasmic reticulum calcium-ATPase (SERCA) involved in excitation-contraction coupling is important in the genesis of staircase phenomenon. Decreased SERCA expression and reduced levels of sarcoplasmic reticulum calcium uptake with consequent diminished force-frequency response is a hallmark of heart failure. There are genetic mutations of SERCA which can enhance the function as well as those which reduce function.

References

1. Usman A, Gandhi J, Gupta G. Physiology, Bowditch Effect. 2023 Jan 30. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 30725706.
2. Balcazar D, Regge V, Santalla M, Meyer H, Paululat A, Mattiazzi A, Ferrero P. SERCA is critical to control the Bowditch effect in the heart. Sci Rep. 2018 Aug 20;8(1):12447. doi: 10.1038/s41598-018-30638-9. PMID: 30127403; PMCID: PMC6102201.