José-Ángel Cabrera1, Robert H Anderson2, Yolanda Macías3, Jorge Nevado-Medina3, Andreu Porta-Sánchez4, José Manuel Rubio5, Damián Sánchez-Quintana3. 1. Unidad de Arritmias, Departamento de Cardiología, Hospital Universitario Quirón-Salud Madrid and Complejo Hospitalario Ruber Juan Bravo, Universidad Europea de Madrid, Centro de Investigación Biomédica en Red (CIBER), Enfermedades Cardiovasculares, Madrid, Spain. Electronic address: jose.cabrera@quironsalud.es. 2. Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom. 3. Departamento de Anatomía Humana y Biología Celular, Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain. 4. Unidad de Arritmias, Departamento de Cardiología, Hospital Universitario Quirón-Salud Madrid and Complejo Hospitalario Ruber Juan Bravo, Universidad Europea de Madrid, Centro de Investigación Biomédica en Red (CIBER), Enfermedades Cardiovasculares, Madrid, Spain; Unidad de Arritmias, Departamento de Cardiología, Hospital Universitario Quirón-Salud Madrid and Complejo Hospitalario Ruber Juan Bravo, Universidad Europea de Madrid Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain. 5. Servicio de Cardiología, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain.
Abstract
OBJECTIVES: This study sought to describe, in detail, the angiographic, gross macroscopy, and histological dissection of the conduction axis in humans. BACKGROUND: The recent upsurge of interest in specific pacing of the atrioventricular conduction axis has emphasized the need for precise knowledge of the location of the atrial and penetrating components of the atrioventricular conduction axis. METHODS: A total of 41 human hearts were studied by serial histological sectioning and an additional 3 hearts by gross dissection. One of the hearts studied histologically was also dissected to show the location of the conduction axis prior to serial sectioning. The anatomical findings were then compared with the results of angiography undertaken in the catheter laboratory in 60 patients undergoing electrophysiological studies. RESULTS: Marked variation of the location of the transition from atrioventricular conduction axis to the penetrating atrioventricular bundle, or the bundle of His, relative to the landmarks of the triangle of Koch was observed. In just over one-half of both the specimens and the patients, the site of penetration was on the atrial aspect of the hinge of the septal leaflet of the tricuspid valve, with further variation noted relative to the apex of the triangle of Koch. Based on measurements of the histological sections, marked variation in the dimensions of the axis and its adjacency to the right-sided endocardium were also found. In almost three-fifths of hearts, an interventricular component of the fibrous membranous septum was not able to be identified. The significance of these findings to those who seek to perform selective pacing of the atrioventricular conduction axis are discussed. CONCLUSIONS: Marked variability of the location of the conduction axis within the triangle of Koch is reported. In three-fifths of hearts, the interventricular component of the fibrous membranous septum is nonexistent.
OBJECTIVES: This study sought to describe, in detail, the angiographic, gross macroscopy, and histological dissection of the conduction axis in humans. BACKGROUND: The recent upsurge of interest in specific pacing of the atrioventricular conduction axis has emphasized the need for precise knowledge of the location of the atrial and penetrating components of the atrioventricular conduction axis. METHODS: A total of 41 human hearts were studied by serial histological sectioning and an additional 3 hearts by gross dissection. One of the hearts studied histologically was also dissected to show the location of the conduction axis prior to serial sectioning. The anatomical findings were then compared with the results of angiography undertaken in the catheter laboratory in 60 patients undergoing electrophysiological studies. RESULTS: Marked variation of the location of the transition from atrioventricular conduction axis to the penetrating atrioventricular bundle, or the bundle of His, relative to the landmarks of the triangle of Koch was observed. In just over one-half of both the specimens and the patients, the site of penetration was on the atrial aspect of the hinge of the septal leaflet of the tricuspid valve, with further variation noted relative to the apex of the triangle of Koch. Based on measurements of the histological sections, marked variation in the dimensions of the axis and its adjacency to the right-sided endocardium were also found. In almost three-fifths of hearts, an interventricular component of the fibrous membranous septum was not able to be identified. The significance of these findings to those who seek to perform selective pacing of the atrioventricular conduction axis are discussed. CONCLUSIONS: Marked variability of the location of the conduction axis within the triangle of Koch is reported. In three-fifths of hearts, the interventricular component of the fibrous membranous septum is nonexistent.
Authors: Giulia Esposito; Niraj Kumar; Francesca Pugliese; Max Sayers; Anthony Wc Chow; Simon Kennon; Mick Ozkor; Anthony Mathur; Andreas Baumbach; Guy Lloyd; Aigerim Mullen; Andrew Cook; Michael Mullen; Kush P Patel Journal: Open Heart Date: 2022-07
Authors: Robert H Anderson; Jill Pjm Hikspoors; Justin T Tretter; Yolanda Macías; Diane E Spicer; Wouter H Lamers; Damián Sánchez-Quintana; Eduardo Back Sternick Journal: Arrhythm Electrophysiol Rev Date: 2021-12