Living anatomy of the atrioventricular junctions. A guide to electrophysiological mapping

Fg, Cosío; Anderson, Richard; Becker, A. E.; Borggrefe, Martin; Rw, Campbell; Gaïta, Fiorenzo; Gm, Guiraudon; Haissaguerre, M.; Kj, Kuck; Jj, Rufilanchas; Thiene, G; Hj, Wellens; Langberg, Jonathan J.; Dg, Benditt; Bharati, Saroja; Klein, G. J.; Marchlinski, Francis E.; Saksena, Sanjeev

doi:10.1053/euhj.1999.1657

Cited by 27 publications

(3 citation statements)

References 23 publications

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“…A decapolar catheter was advanced to the coronary sinus vein through the subclavian vein. Manifest preexcitation was defined as the presence of a delta wave on surface ECG and an intracardiac His-ventricle time of less than 35 ms. By standard mapping methods and techniques [23], the site of the AP was identified and ablated. RFA was considered successful if both antegrade and retrograde AP conduction were abolished for at least 30 min after RFA during the procedure.…”

Section: Methodsmentioning

confidence: 99%

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LV dyssynchrony as assessed by phase analysis of gated SPECT myocardial perfusion imaging in patients with Wolff-Parkinson-White syndrome

Chen

Miao

et al. 2012

Eur J Nucl Med Mol Imaging

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Purpose The purpose of this study was to evaluate left ventricular (LV) mechanical dyssynchrony in patients with Wolff-Parkinson-White (WPW) syndrome pre- and post-radiofrequency catheter ablation (RFA) using phase analysis of gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). Methods Forty-five WPW patients were enrolled and had gated SPECT MPI pre- and 2–3 days post-RFA. Electrophysiological study (EPS) was used to locate accessory pathways (APs) and categorize the patients according to the AP locations (septal, left and right free wall). Electrocardiography (ECG) was performed pre- and post-RFA to confirm successful elimination of the APs. Phase analysis of gated SPECT MPI was used to assess LV dyssynchrony pre- and post-RFA. Results Among the 45 patients, 3 had gating errors, and thus 42 had SPECT phase analysis. Twenty-two patients (52.4 %) had baseline LV dyssynchrony. Baseline LV dyssynchrony was more prominent in the patients with septal APs than in the patients with left or right APs (p<0.05). RFA improved LV synchrony in the entire cohort and in the patients with septal APs (p<0.01). Conclusion Phase analysis of gated SPECT MPI demonstrated that LV mechanical dyssynchrony can be present in patients with WPW syndrome. Septal APs result in the greatest degree of LV mechanical dyssynchrony and afford the most benefit after RFA. This study supports further investigation in the relationship between electrical and mechanical activation using EPS and phase analysis of gated SPECT MPI.

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Section: Methodsmentioning

confidence: 99%

“…The site of successful ablation of the AP for each patient was recorded on fluoroscopy according to the method mentioned above (also in [23]). All of the patients were categorized into three subgroups according to the sites of the APs in the septal wall, right free wall, or left free wall, respectively.…”

Section: Methodsmentioning

confidence: 99%

LV dyssynchrony as assessed by phase analysis of gated SPECT myocardial perfusion imaging in patients with Wolff-Parkinson-White syndrome

Chen

Miao

et al. 2012

Eur J Nucl Med Mol Imaging

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“…So as to permit direct comparisons with the human heart, we orientated the bovine images so as to match the attitudinally appropriate terminology for human anatomy (Anderson & Loukas, 2009;Cosío et al, 1999;De Almeida et al, 2019;McAlpine, 1975;Mori et al, 2019b;Walmsley, 1958). Thus, cranial, caudal, ventral, and dorsal structures in the ox are described as being superior, inferior, anterior, and posterior, respectively.…”

Section: Attitudinal Descriptionmentioning

confidence: 99%

Three‐dimensional visualization of the bovine cardiac conduction system and surrounding structures compared to the arrangements in the human heart

Almeida¹,

Mori

Anderson

2021

Journal of Anatomy

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In the human heart, the atrioventricular node is located toward the apex of the triangle of Koch, which is also at the apex of the inferior pyramidal space. It is adjacent to the atrioventricular portion of the membranous septum, through which it penetrates to become the atrioventricular bundle. Subsequent to its penetration, the conduction axis is located on the crest of the ventricular septum, sandwiched between the muscular septum and ventricular component of the membranous septum, where it gives rise to the ramifications of the left bundle branch. In contrast, the bovine conduction axis has a long non-branching component, which penetrates into a thick muscular atrioventricular septum having skirted the main cardiac bone and the rightward half of the non-coronary sinus of the aortic root. It commonly gives rise to both right and left bundle branches within the muscular ventricular septum. Unlike the situation in man, the left bundle branch is long and thin before it branches into its fascicles.These differences from the human heart, however, have yet to be shown in threedimensions relative to the surrounding structures. We have now achieved this goal by injecting contrast material into the insulating sheaths that surround the conduction network, evaluating the results by subsequent computed tomography. The fibrous atrioventricular membranous septum of the human heart is replaced in the ox by the main cardiac bone and the muscular atrioventricular septum. The apex of the inferior pyramidal space, which in the bovine, as in the human, is related to the atrioventricular node, is placed inferiorly relative to the left ventricular outflow tract. The bovine atrioventricular conduction axis, therefore, originates from a node itself located inferiorly compared to the human arrangement. The axis must then skirt the non-coronary sinus of the aortic root prior to penetrating the thicker muscular ventricular septum, thus accounting for its long non-branching course. We envisage that our findings will further enhance comparative anatomical research.

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Anatomy of the human atrioventricular junctions revisited

2000

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There have been suggestions made recently that our understanding of the atrioventricular junctions of the heart is less than adequate, with claims for several new findings concerning the arrangement of the ordinary working myocardium and the specialised pathways for atrioventricular conduction. In reality, these claims are grossly exaggerated. The structure and architecture of the pathways for conduction between the atrial and ventricular myocardium are exactly as described by Tawara nearly 100 years ago. The recent claims stem from a failure to assess histological findings in the light of criterions established by Monckeberg and Aschoff following a similar controversy in 1910. The atrioventricular junctions are the areas where the atrial myocardium inserts into, and is separated from, the base of the ventricular mass, apart from at the site of penetration of the specialised axis for atrioventricular conduction. There are two such junctions in the normal heart, surrounding the orifices of the mitral and tricuspid valves. The true septal area between the junctions is of very limited extent, being formed by the membranous septum. Posterior and inferior to this septal area, the atrial myocardium overlies the crest of the ventricular septum, with the atrial component being demarcated by the landmarks of the triangle of Koch. The adjacent structures, and in particular the so‐called inferior pyramidal space, were accurately described by McAlpine (Heart and Coronary Arteries, 1975). Thus, again there is no need for revision of our understanding. The key to unravelling much of the alleged controversy is the recognition that, as indicated by Tawara, the atrioventricular node becomes the atrioventricular bundle at the point where the overall axis for conduction penetrates into the central fibrous body. There are also marked differences in arrangement, also described by Tawara, between the disposition of the conduction axis in man as compared to the dog. Anat Rec 260:81–91, 2000. © 2000 Wiley‐Liss, Inc.

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Living anatomy of the atrioventricular junctions. A guide to electrophysiological mapping

Cited by 27 publications

References 23 publications

LV dyssynchrony as assessed by phase analysis of gated SPECT myocardial perfusion imaging in patients with Wolff-Parkinson-White syndrome

LV dyssynchrony as assessed by phase analysis of gated SPECT myocardial perfusion imaging in patients with Wolff-Parkinson-White syndrome

Three‐dimensional visualization of the bovine cardiac conduction system and surrounding structures compared to the arrangements in the human heart

Anatomy of the human atrioventricular junctions revisited

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