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Eur J Cardiothorac Surg 2006;29:S56-S60
© 2006 Elsevier Science NL

Review

Left ventricular muscle band (VMB): thoughts on its physiologic and clinical implications

Division of Cardiothoracic Surgery, Washington University School of Medicine, 660 S. Euclid Ave., Box 8234, St. Louis, MO 63110, USA

Received 17 February 2006; accepted 28 February 2006.

^_* Corresponding author. Tel.: +1 314 362 8311; fax: +1 314 361 8706. (Email: schuesslerd{at}wustl.edu).

Although the ventricular muscle band (VMB) is formed by one continuous band of myocardium and there is some evidence to suggest that it may contract sequentially along its course from the right ventricle, through the septum, then along its basoapical left ventricular spiral, the structure is not activated in this sequence. Activation as programmed by the fully developed Purkinje system proceeds broadly and directly from endocardium to epicardium and from apex to base. Although not activated sequentially along its course, the band may still contract and relax sequentially if there is a progressive lengthening of the contraction duration in association with a nonuniform lengthening of the cardiac fiber action potential (repolarization) duration. Also, the systolic and diastolic functions of the band should be considered as part of a complex, integrated electromechanical system in which the activation is programmed to ensure optimal function.

Key Words: Ventricular myocardial band • Ventricular activation and repolarization • Specialized ventricular conduction (Purkinje) system • Excitation–contraction coupling

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