The left ventricular summit (LVS) is a triangular area located at the
most superior portion of the left epicardial ventricular region,
surrounded by the two branches of the left coronary artery: the left
anterior interventricular artery and the left circumflex artery. The
triangle is bounded by the apex, septal and mitral margins and base.
This review aims to provide a systematic and comprehensive anatomical
description and proper terminology in the LVS region that may facilitate
exchanging information among anatomists and electrophysiologists,
increasing knowledge of this cardiac region. We postulate that the most
dominant septal perforator (not the first septal perforator) should
characterize the LVS definition. Abundant epicardial adipose tissue
overlying the LVS myocardium may affect arrhythmogenic processes and
electrophysiological procedures within the LVS region. The LVS is
divided into two clinically significant regions: accessible and
inaccessible areas. Rich arterial and venous coronary vasculature and a
relatively dense network of cardiac autonomic nerve fibers are present
within the LVS boundaries. Although the approach to the LVS may be
challenging, it can be executed indirectly using the surrounding
structures. Delivery of the proper radiofrequency energy to the
arrhythmia source, avoiding coronary artery damage at the same time, may
be a challenge. Therefore, coronary angiography or cardiac computed
tomography imaging is strongly recommended before any procedure within
the LVS region. Further research on LVS morphology and physiology should
increase the safety and effectiveness of invasive electrophysiological
procedures performed within this region of the human heart.
Published in Diagnostics:
https://doi.org/10.3390/diagnostics11081423