Electrophysiological Bases of Torsion and Suction in the Continuous Cardiac Band Model

Abstract

Objective: Torrent Guasp concept, that postulates that the ventricles are formed by a continuous muscle band, provides the basis for two aspects of left ventricular dynamics: The torsion mechanism and the rapid early diastolic filling by the suction effect. We investigated the electrophysiological basis of this mechanism, by electroanatomical left ventricular endoepicardial mapping (EEM) in five patients, during radiofrequency ablation. Results: The apical loop is activated by a simultaneous depolarization of the distal descending and proximal ascending band segments. At the point of crossing of both bands a radial activation spreads from the descending to the ascending band. From this point, begins a simultaneous and opposing activation of the proximal and distal ascending band. The activation of the distal ascending band segment is the latest. Conclusions: The activation sequence of the continuous band provides an electrophysiological basis for the ventricular torsion and suction mechanism.