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Eur J Cardiothorac Surg 2006;29:S178-S187
© 2006 Elsevier Science NL

Review

‘The electrical spiral of the heart’: its role in the helical continuum.

The hypothesis of the anisotropic conducting matrix

^a University of Alabama at Birmingham, Division of Cardiovascular Diseases, THT 321 N, University Station, Birmingham, AL 35294, United States
^b Arthur Andersen, Chicago, IL, United States
^c Option on Bioengineering, California Institute of Technology, Pasadena, CA, United States
^d David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
^e Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, United States

Received 17 February 2006; accepted 28 February 2006.

^_* Corresponding author. Tel.: +1 205 934 3897; fax: +1 205 934 1279. (Email: ccoghlan{at}cardio.dom.uab.edu).

The study of the dissemination of the electrical impulse throughout the ventricular myocardium, which gave rise to the current theories, was carried out without taking into consideration the complex architecture of the cardiac muscle elucidated by more recent researchers. We propose a novel hypothesis based on the special macroscopic structure of the heart, the anisotropic electrical and mechanical behavior of the myocardium, the characteristics of the intercellular matrix and its very special collagen scaffolding, chemical composition, and biochemistry. The unique properties of the intercellular matrix would make it especially suited to function, in conjunction with the specialized conducting system (His–Purkinje system) as an efficient anisotropic conductor for the spread of electrical activation in the heart in order to allow an optimal sequence of excitation–contraction coupling that results in the coordination of effective myocardial contraction in birds and mammals of the most varied known heart rates. An analysis of certain clinical conditions that raise questions regarding current hypothesis and a review of novel techniques for recording transmembrane and extracellular potentials, which will provide a much firmer basis for the study of cardiac activation and the influence of myofiber architecture and which will allow in depth testing of hypotheses are presented.

Key Words: Electrophysiology • Excitation • Contraction • Myocardium • Activation • Conduction • Fiber architecture • Myocardial band and spiral • Intercellular matrix