Author + information
- Received July 29, 2019
- Revision received December 2, 2019
- Accepted December 3, 2019
- Published online April 20, 2020.
- José-Ángel Cabrera, MD, PhDa,∗ ( )(, )
- Robert H. Anderson, MDb,
- Yolanda Macías, PhDc,
- Jorge Nevado-Medina, MScc,
- Andreu Porta-Sánchez, MD, PhDa,d,
- José Manuel Rubio, MDe and
- Damián Sánchez-Quintana, MD, PhDc
- aUnidad 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
- bInstitute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
- cDepartamento de Anatomía Humana y Biología Celular, Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain
- dUnidad 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
- eServicio de Cardiología, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
- ↵∗Address for correspondence:
Prof. José-Ángel Cabrera, Departamento de Cardiología, Hospital Universitario Quirón-Salud Madrid and Complejo Hospitalario Ruber Juan Bravo, Universidad Europea de Madrid, CIBER Enfermedades Cardiovasculares, 1 Diego de Velázquez, Pozuelo de Alarcón, Madrid, Spain.
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.
- atrioventricular node
- bundle of His
- membranous septum
- penetrating atrioventricular bundle
The authors have received Plan Estatal de Investigación Científica y Técnica y de Innovación 2013 to 2016 from the Ministerio de Economía, Industria y Competitividad of Spain and Fondo Europeo de Desarrollo Regional (FEDER) DPI2016-75799-R (AEI/FEDER, UE). Dr. Porta-Sánchez has received travel grants from Biosense Webster; and is a consultant for Abbott Laboratories. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received July 29, 2019.
- Revision received December 2, 2019.
- Accepted December 3, 2019.
- 2020 American College of Cardiology Foundation
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