Trainini Jorge, MD, PhD1*, Valle Cabezas Jesús, Ingeniero2, Beraudo Mario, MD3, Elencwajg Benjamín, MD4 .Wernicke Mario, MD5, Trainini Alejandro, MD6, Bastarrica María Elena, MD7, Lowenstein Jorge, MD8, Hernández López Mayra P, MD9, Lowenstein-Haber Diego, MD10, Carreras Costa Francesc11, Mora Llabata Vicente12 and García Fernandez Miguel Angel13

Objective: Through research that we have carried out continuously in recent years and that includes the sequence of cardiac activation, anatomical studies, physiological experiences on the protodiastolic phase, ventricular septal interdependence, clinical and experimental research on negative intraventricular pressure and the suction mechanism, we reach the understanding of biventricular complementarity.
Methods: The endo- and epicardial electrical activation sequence of the left ventricle has been studied using three-dimensional electroanatomical mapping with a Carto navigation that allows a three-dimensional anatomical representation, including five patients.
Results: Diastole is divided into two phases. In the first, the ventricular volume does not vary, it is isometric, but with energy expenditure its morphology changes generating intraventricular negative pressure, call protodiastolic phase of myocardial contraction. During the second phase, ventricular filling occurs without energy expenditure.
Conclusions: The asynchrony between the RV and LV cycles allows the interaction between expulsion and loading of each of them.

Keywords: Cardiac suction; Myocardium; Proto-diastolic phase; Complementarity ventricular.
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