Gross anatomy of the human cardiac conduction system with comparative morphological and developmental implications for human application

Kawashima, Tomokazu; Sasaki, Hiroshi

doi:10.1016/j.aanat.2010.11.002

Cited by 32 publications

(24 citation statements)

References 81 publications

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“…The mean value of the sensed R wave showed acceptable and stable values despite the challenging HB position enclosed in a fibrous body . Median implant time (79 minutes) and median fluoroscopy time (10 minutes) compare well with the published data .…”

Section: Discussionsupporting

confidence: 79%

Long term performance and safety of His bundle pacing: A multicenter experience

Zanon

Abdel‐Rahman

Marcantoni

et al. 2019

Cardiovasc electrophysiol

123

102

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Introduction Several single‐center short‐term studies have demonstrated the feasibility, safety, and positive clinical outcomes of permanent His bundle pacing (HBP). We performed a retrospective study to evaluate long‐term technical and safety performances of HBP in a large population of pacemaker patients from two different centers. Methods and Results The analysis includes 844 patients (345 female, mean age = 75 ± 9 years) who underwent successful permanent HBP for pacemaker indications from 2004 to 2016. The main endpoints were long term electrical performances including pacing threshold, sensing, impedance, and freedom from pacing related complications. The pacing indication was AV Block in 348 (41.2%) patients, sinus node disease in 147 (17.4%), any bradycardia indication in patients with atrial fibrillation in 335 (39.7%) patients and need for cardiac resynchronization therapy in 14 (1.7%) patients. Mean pacing capture thresholds and sensed R waves were 1.6 V and 5.8 mV, respectively at implant and 2.0 V and 6.1 mV at chronic follow‐up. During the median follow up of 3 years (interquartile range = 1‐6 years), HBP was free of any complication in 91.6% of patients. In the first 368 patients, HBP was achieved using a deflectable curve delivery system, while in 476 using the fixed curve sheath. A significant difference was found in the thresholds (2.4 ± 1.0 V and 1.7 ± 1.1 V, P < .001, respectively) and complications (11.9% and 4.2%, P < .001, respectively) between the two groups. Conclusions Permanent HBP was safe and effective during long‐term follow‐up. The fixed curved delivery sheath offered significantly better electrical parameters and reliability over time. The results of this multicenter study are consistent with recent studies.

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Section: Discussionsupporting

confidence: 79%

Long term performance and safety of His bundle pacing: A multicenter experience

Zanon

Abdel‐Rahman

Marcantoni

et al. 2019

Cardiovasc electrophysiol

123

102

View full text Add to dashboard Cite

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“…This indicates that the “amount” of cardiac amyloid deposition may be one of the determinants of conduction abnormalities in cardiac AL amyloidosis. Although myocardial amyloid deposition is not homogenous, as recently described by Leone and coworkers, it appears very likely that a higher septal thickness increases the likelihood of specialized conduction system damage …”

Section: Discussionmentioning

confidence: 82%

Prevalence and Prognostic Value of Conduction Disturbances at the Time of Diagnosis of Cardiac AL Amyloidosis

Boldrini

Salinaro

Mussinelli

et al. 2013

Noninvasive Electrocardiol

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“…It is not positioned in the medial wall of the right atrium, as still shown in some textbooks (Paulsen and Waschke ). It is also unfortunate that several textbooks continue to illustrate “specialized internodal tracts” (Table ), despite the absence of anatomical evidence to validate their existence (Janse and Anderson ; Kawashima and Sasaki ). Furthermore, Koch's triangle itself is rarely mentioned in either old or current textbooks (Testut and Latarjet ; Chiarurgi ; DiDio ; Drenckhahn ; Standring , ; Paulsen and Waschke ).…”

Section: Attitudinal Description Of the Conduction Systemmentioning

confidence: 99%

“…Some have claimed that components of the conduction system such as the atrioventricular node, the penetrating bundle, and the right bundle branch can be dissected in both man and animals (Yanagawa and Nakajima ; Kawashima and Sasaki ; De Almeida et al ), but it is questionable whether gross dissection can be achieved with uniform accuracy. The left bundle and its branches have proved particularly difficult to demonstrate in human hearts (Uhley and Rivkin ; Massing and James ; Sakaguchi et al ; Yanagawa and Nakajima ; Kawashima and Sasaki ; Anderson ; Kawashima and Sato ). Nevertheless, Tawara's original account (Tawara ) showed the variability in its morphology as revealed by its visualization in the gross heart, illustrating human hearts with trifascicular and fan patterns (Fig.…”

Section: Macroscopic Examination Of the Intraventricular Conduction Smentioning

confidence: 99%

Why do we break one of the first rules of anatomy when describing the components of the heart?

2019

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A rule of human anatomy is that all structures within the body should be described relative to the so-called "anatomical position." Along with those describing structures such as the skull and liver, those accounting for the components of the heart consistently break this rule, describing the organ as if removed from the body and positioned on its apex, the so-called "Valentine position." Although potentially appropriate to some animal species, this approach produces problems when used in human anatomy, even if the right and left ventricles are only viewed in truly right-sided and left-sided positions when assessed in the Valentine fashion. The names of the ventricles, of course, are never going to change. This is not necessarily the case with other cardiac components. Consider the artery that extends between the ventricles on their diaphragmatic surface. Blockage produces inferior myocardial infarction, which is to be expected, since the vessel is located in inferior and interventricular position. It is incorrect to describe the artery as being posterior and descending. Such infelicities are now the more obvious with the advent of techniques that, in clinical cardiology, show the components of the heart as it lies within the chest. In this review, we have assessed the frequency of use of the Valentine approach in popular textbooks used by students of human anatomy. We show that, using the conduction tissues as a model, this system also being incorrectly described in the majority of the textbooks, the situation can be improved by use of attitudinally appropriate description. Clin. Anat. 32:585-596, 2019.

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Gross anatomy of the human cardiac conduction system with comparative morphological and developmental implications for human application

Cited by 32 publications

References 81 publications

Long term performance and safety of His bundle pacing: A multicenter experience

Long term performance and safety of His bundle pacing: A multicenter experience

Prevalence and Prognostic Value of Conduction Disturbances at the Time of Diagnosis of Cardiac AL Amyloidosis

Why do we break one of the first rules of anatomy when describing the components of the heart?

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