Stimulus Propagation and Left Ventricular Torsion
Journal Title: Advancements in Cardiovascular Research - Year 2018, Vol 1, Issue 2
Abstract
Introduction and objectives: The ventricular myocardium consists of a continuous muscular band. This anatomy would provide the interpretation for two fundamental aspects of left ventricular dynamics: the mechanism of left ventricular twist and rapid diastolic filling due to the suction effect. The aim of this study was to investigate the electrical activation of the endocardial and epicardial bands to understand ventricular twist and the mechanism of active suction during the diastolic isovolumic phase. Methods: Five patients underwent three-dimensional endoepicardial electro anatomic mapping during ablation of lone atrial fibrilation or concealed epicardial accessory pathways. Results: Three-dimensional endo-epicardial mapping demonstrates an electrical activation sequence in the area of the apex loop in agreement with the synchronic contraction of the descending and ascending band segments. The simultaneous and opposing radial activation of the ascending band segment, starting in the descending band segment, in the area in which both band segments intertwine, is consistent with the mechanism of ventricular twist. The late activation of the ascending band segment is consistent with its persistent contraction during the initial period of the isovolumic diastolic phase (the basis of the suction mechanism). Conclusion: This study could explain the process of ventricular twist during systole and the active diastolic suction The Torrent Guasp’s continuous ventricular myocardial band hypothesis in cardiac mechanics implies a series of associated muscular movements [1]. For this author the ventricular myocardium consists of a continuous muscular band originating in the pulmonary valve and extending to the aortic root, thus limiting the two ventricular chambers (Figure 1). In its spatial trajectory two muscle bands can be identified: the descending endocardial band and the ascending epicardial band, twisted in a double helical coil forming a basal loop (left and right basal segments) and an apical loop (descending and ascending apical segments). In this spatial arrangement, the descending and ascending bands cross each other at a point we will call “segment intersection” (Figure 2). According to this author the movements of left ventricular narrowing, shortening, twisting, lengthening, untwisting and expansion phases during the cardiac cycle would occur by longitudinal diffusion of stimuli along the ventricular myocardial band.
Authors and Affiliations
Trainini Jorge, Elencwajg Benjamín, López Cabanillas Néstor, Herreros Jesús, Lago Noemí, Lowenstein Jorge, Bustamante Munguira Juan
Keywords
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- EP ID EP586151
- DOI 10.32474/ACR.2018.01.000109
- Views 95
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