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Barrows IR, Sahara N, Ellenbogen KA, Tung R. High-Density Mapping and Fasciculoventricular Pathways. JACC Clin Electrophysiol 2025:S2405-500X(25)00091-X. [PMID: 40208156 DOI: 10.1016/j.jacep.2025.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 01/10/2025] [Accepted: 02/12/2025] [Indexed: 04/11/2025]
Affiliation(s)
- Ian R Barrows
- Department of Internal Medicine, Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA.
| | - Naohiko Sahara
- Division of Cardiology, University of Arizona College of Medicine-Phoenix, Banner-University Medical Center, Phoenix, Arizona, USA
| | - Kenneth A Ellenbogen
- Department of Internal Medicine, Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Roderick Tung
- Division of Cardiology, University of Arizona College of Medicine-Phoenix, Banner-University Medical Center, Phoenix, Arizona, USA
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Tretter JT, Bedogni F, Rodés-Cabau J, Regueiro A, Testa L, Eleid MF, Chen S, Galhardo A, Ellenbogen KA, Leon MB, Ben-Haim S. Novel cardiac CT method for identifying the atrioventricular conduction axis by anatomic landmarks. Heart Rhythm 2025; 22:776-785. [PMID: 39706459 DOI: 10.1016/j.hrthm.2024.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2024] [Revised: 12/11/2024] [Accepted: 12/12/2024] [Indexed: 12/23/2024]
Abstract
BACKGROUND Understanding the conduction axis location aids in avoiding iatrogenic damage and guiding targeted heart rhythm therapy. OBJECTIVE Cardiac structures visible with clinical imaging have been demonstrated to correlate with variability in the conduction system course. We aimed to standardize and assess the reproducibility of predicting the location of the atrioventricular conduction axis by cardiac computed tomography. METHODS We evaluated 477 patients with acquired aortic valve disease by cardiac computed tomography to assess variability in cardiac structures established to relate to the conduction system. We standardized 3 points (points A-C) to estimate the course from the atrioventricular node to the nonbranching bundle and left bundle branch origin and further compared this with measures of variability in the aortic root and membranous septum. RESULTS The mean distances between the aortic valve virtual basal ring and points A, B, and C were 9.5 ± 3.5 (0.3-20.1) mm, 5.0 ± 2.6 (-1.7 to 15.9) mm, and 2.9 ± 2.5 (-5.2 to 12.0) mm, respectively. The midpoint of the membranous septum deviated posteriorly a median of -4.4 (interquartile range, -12.4 to +3.0) degrees relative to the commissure between the right coronary and noncoronary leaflets. Intraclass coefficients for both intraobserver and interobserver variability for all measured points were excellent (≥0.78). CONCLUSION These findings further infer the intimate yet highly variable relationship between the conduction axis and aortic root. This reproducible and standardized approach needs validation in populations of patients requiring accurate identification of the atrioventricular components of the conduction axis, which may serve as a noninvasive means for estimating its location.
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Affiliation(s)
| | | | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | | | | | - Shmuel Chen
- NewYork-Presbyterian/Weill Cornell, New York, New York
| | - Attilio Galhardo
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Martin B Leon
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, Cardiovascular Research Foundation, New York, New York
| | - Shlomo Ben-Haim
- Hobart Healthcare Research Institute, London, United Kingdom
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3
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Prasitlumkum N, Futela P, Cannon BC, Wackel PL, Kowlgi GN. An acquired manifestation of fasciculoventricular pathway following complex congenital heart disease repair. HeartRhythm Case Rep 2025; 11:79-81. [PMID: 40330682 PMCID: PMC12049715 DOI: 10.1016/j.hrcr.2024.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2025] Open
Affiliation(s)
- Narut Prasitlumkum
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Pragyat Futela
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Bryan C. Cannon
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Phillip L. Wackel
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Mahmud R, Lee J, Mohan A, Lee M, Phillips B, Hakes S, Talaei F, Back Sternick E. Outcomes with physiologic His bundle pacing in patients with narrow QRS complex. Heart Rhythm 2024; 21:2563-2570. [PMID: 38908462 DOI: 10.1016/j.hrthm.2024.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 06/13/2024] [Accepted: 06/15/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND In patients with narrow QRS complex, both ventricular and biventricular pacing is associated with increased cardiac morbidity and mortality. This risk is not decreased by ventricular pacing avoidance algorithms, which cause nonphysiologic atrioventricular (AV) delays. OBJECTIVE This study aimed to report outcomes in patients with narrow QRS complex when the paced complex is in normal range and physiologic AV delays are programmed. METHODS In 196 patients with QRS duration of 92 ± 10 ms, permanent pacing was done at the site of the His bundle electrogram. The pacemakers were then programmed to maintain physiologic AV delays and to increase heart rates in response to exercise. Patients received usual care and were observed for 3 years. RESULTS The paced complex exhibited a delta wave, and the ventricular activation time, QRS axis, and lead I voltage remained in normal range. Physiologic programming resulted in His bundle pacing burden of 92%. In patients with decreased ejection fraction, there was significant improvement in left ventricular function, left ventricular dilation, and mitral regurgitation (P < .003). In patients with normal ejection fraction, left ventricular function remained normal without new valvular abnormalities. The 3-year all-cause mortality was 10%, and there was no increase in heart failure admissions. CONCLUSION In patients with narrow QRS complex, when paced QRS morphology is maintained in normal range and AV dyssynchrony is avoided, His bundle pacing is associated with low all-cause mortality and improvement in abnormal echocardiographic parameters. The paced QRS morphology and physiologic AV delays may be important factors to evaluate in future trials of conduction system pacing.
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Affiliation(s)
- Rehan Mahmud
- McLaren Bay Region Medical Center, Bay City, Michigan
| | - Jenna Lee
- College of Medicine, Central Michigan University, Mt Pleasant, Michigan
| | - Ayush Mohan
- College of Medicine, Central Michigan University, Mt Pleasant, Michigan
| | - Matt Lee
- College of Medicine, Central Michigan University, Mt Pleasant, Michigan
| | | | - Sharon Hakes
- McLaren Bay Region Medical Center, Bay City, Michigan
| | | | - Eduardo Back Sternick
- Electrophysiology Department, Mater Dei Hospital, Belo Horizonte, Minas Gerais, Brazil.
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Tretter JT, Koneru JN, Spicer DE, Ellenbogen KA, Anderson RH, Ben-Haim S. A new dimension in cardiac imaging: Three-dimensional exploration of the atrioventricular conduction axis with hierarchical phase-contrast tomography. Heart Rhythm 2024; 21:2388-2396. [PMID: 39370026 DOI: 10.1016/j.hrthm.2024.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Revised: 09/27/2024] [Accepted: 10/01/2024] [Indexed: 10/08/2024]
Abstract
Much of our understanding of the atrioventricular conduction axis has been derived from early 20th-century histologic investigations. These studies, although foundational, are constrained by their 2-dimensional representation of complex 3-dimensional anatomy. The variability in the course of the atrioventricular conduction axis, and its relationship to surrounding cardiac structures, necessitates a more advanced imaging approach. Using hierarchical phase-contrast tomography of an autopsied heart specimen with cellular resolution, this review provides a contemporary understanding of the atrioventricular conduction axis. By correlating these findings with 3-dimensional computed tomographic reconstructions in living patients, we offer clinicians the insights needed accurately to predict the location of the atrioventricular conduction axis. This novel approach overcomes the inherent limitations of 2-dimensional histology, enhancing our ability to understand and visualize the intricate relationships of the conduction axis within the heart.
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Affiliation(s)
| | - Jayanthi N Koneru
- Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Diane E Spicer
- Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | | | | | - Shlomo Ben-Haim
- Hobart Healthcare Research Institute, London, United Kingdom
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Anderson RH, Sánchez-Quintana D, Spicer DE, Macías Y, Cook AC, Cabrera JA, Mahmud R, Sternick EB, Tretter JT. Revisiting the Atrioventricular Conduction Axis for the 21st Century. Arrhythm Electrophysiol Rev 2024; 13:e20. [PMID: 39588052 PMCID: PMC11588108 DOI: 10.15420/aer.2024.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 05/06/2024] [Indexed: 11/27/2024] Open
Abstract
In this review, we summarise the ongoing debate surrounding the anatomy of the atrioventricular conduction axis and its relevance to pacing. We highlight previous disagreements and emphasise the importance of understanding the anatomical location of the axis. We give credit and support to the initial descriptions by His and Tawara, in particular their attention to the relationship of the atrioventricular conduction axis with the membranous septum. We express our disagreements with recent diagrams that incorrectly, in our opinion, depict the left bundle and right bundle branches. We offer our own latest understanding of the location and relationships of the atrioventricular conduction axis, including details of its development, and differences between human and animal hearts. We also emphasise the importance of understanding the relationship between the inferior pyramidal space and the inferoseptal recess so as appropriately to place the axis within the heart. We conclude by emphasising the need to consider the heart in the context of the body, describing its component parts by using attitudinally appropriate nomenclature.
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Affiliation(s)
| | - Damián Sánchez-Quintana
- Department of Human Anatomy and Cell Biology, Faculty of Medicine, University of Extremadura Badajoz, Spain
| | - Diane E Spicer
- Congenital Heart Center, All Children's Hospital St Petersberg, FL, US
| | - Yolanda Macías
- Department of Medical and Surgical Therapeutics, Faculty of Veterinary, University of Extremadura Cáceres, Spain
| | - Andrew C Cook
- Cardiovascular Sciences Institute, University College London London, UK
| | - José-Angel Cabrera
- Unidad de Arritmias, Departamento de Cardiología, Hospital Universitario Quirón-Salud Madrid, Spain
- Complejo Hospitalario Ruber Juan Bravo, Universidad Europea de Madrid Madrid, Spain
| | - Rehan Mahmud
- Cardiac Electrophysiology Department, McLaren Bay Region Bay City, MI, US
| | | | - Justin T Tretter
- Department of Pediatric Cardiology, Cleveland Clinic Children's Cleveland, OH, US
- The Heart, Vascular, and Thoracic Institute, Cleveland Clinic Cleveland, OH, US
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Jastrzębski M, Foley P, Chandrasekaran B, Whinnett Z, Vijayaraman P, Upadhyay GA, Schaller RD, Gardas R, Richardson T, Kudlik D, Stadler RW, Zimmerman P, Burrell J, Waxman R, Cornelussen RN, Lyne J, Herweg B. Multicenter Hemodynamic Assessment of the LOT-CRT Strategy: When Does Combining Left Bundle Branch Pacing and Coronary Venous Pacing Enhance Resynchronization?: Primary Results of the CSPOT Study. Circ Arrhythm Electrophysiol 2024; 17:e013059. [PMID: 39440428 PMCID: PMC11575906 DOI: 10.1161/circep.124.013059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 08/15/2024] [Indexed: 10/25/2024]
Abstract
BACKGROUND Left bundle branch area pacing (LBBAP) may be an alternative to biventricular pacing (BVP) for cardiac resynchronization therapy (CRT). We sought to compare the acute hemodynamic and ECG effects of LBBAP, BVP, and left bundle-optimized therapy CRT (LOT-CRT) in CRT candidates with advanced conduction disease. METHODS In this multicenter study, 48 patients with either nonspecific interventricular conduction delay (n=29) or left bundle branch block (n=19) underwent acute hemodynamic testing to determine the change in left ventricular pressure maximal first derivative (LV dP/dtmax) from baseline atrial pacing to BVP, LBBAP, or LOT-CRT. RESULTS Atrioventricular-optimized increases in LV dP/dtmax for LOT-CRT (mean, 25.8% [95% CI, 20.9%-30.7%]) and BVP (26.4% [95% CI, 20.2%-32.6%]) were greater than unipolar LBBAP (19.3% [95% CI, 15.0%-23.7%]) or bipolar LBBAP (16.4% [95% CI, 12.7%-20.0%]; P≤0.005). QRS shortening was greater in LOT-CRT (29.5 [95% CI, 23.4-35.6] ms) than unipolar LBBAP (11.9 [95% CI, 6.1-17.7] ms), bipolar LBBAP (11.7 ms [95% CI, 6.4-17.0]), or BVP (18.5 [95% CI, 11.0-25.9] ms), all P≤0.005. Compared with patients with left bundle branch block, patients with interventricular conduction delay experienced less QRS reduction (P=0.026) but similar improvements in LV dP/dtmax (P=0.29). Bipolar LBBAP caused anodal capture in 54% of patients and resulted in less LV dP/dtmax improvement than unipolar LBBAP (18.6% versus 23.7%; P<0.001). Subclassification of LBBAP capture (European Heart Rhythm Association criteria) indicated LBBAP or LV septal pacing in 27 patients (56%) and deep septal pacing in 21 patients (44%). The hemodynamic benefit of adding left ventricular coronary vein pacing to LBBAP depended on baseline QRS duration (P=0.031) and success of LBBAP (P<0.004): LOT-CRT provided 14.5% (5.0%-24.1%) greater LV dP/dtmax improvement and 20.8 (12.8-28.8) ms greater QRS shortening than LBBAP in subjects with QRS ≥171 ms and deep septal pacing capture type. CONCLUSIONS In a CRT cohort with advanced conduction disease, LOT-CRT and BVP provided greater acute hemodynamic benefit than LBBAP. Subjects with wider QRS or deep septal pacing are more likely to benefit from the addition of a left ventricular coronary vein lead to implement LOT-CRT. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04905290.
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Affiliation(s)
- Marek Jastrzębski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland (M.J.)
| | - Paul Foley
- Wiltshire Cardiac Center, Great Western Hospital, Swindon, United Kingdom (P.F., B.C.)
| | | | - Zachary Whinnett
- Division of Cardiology, National Heart and Lung Institute, Imperial College, London, United Kingdom (Z.W.)
| | - Pugazhendhi Vijayaraman
- Division of Cardiology, Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes-Barre, PA (P.V.)
| | - Gaurav A. Upadhyay
- Center for Arrhythmia Care, Section of Cardiology, University of Chicago, Pritzker School of Medicine, IL (G.A.U.)
| | - Robert D. Schaller
- Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (R.D.S.)
| | - Rafał Gardas
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland (R.G.)
| | - Travis Richardson
- Division of Cardiovascular Medicine, Vanderbilt Heart, Nashville, TN (T.R.)
| | - D’Anne Kudlik
- Medtronic, Minneapolis, MN (D.K., R.W.S., P.Z., J.B., R.W.)
| | | | | | - James Burrell
- Medtronic, Minneapolis, MN (D.K., R.W.S., P.Z., J.B., R.W.)
| | - Robert Waxman
- Medtronic, Minneapolis, MN (D.K., R.W.S., P.Z., J.B., R.W.)
| | | | - Jonathan Lyne
- Division of Cardiac Electrophysiology, Beacon Hospital (UCD), Dublin, Ireland (J.L.)
| | - Bengt Herweg
- Division of Cardiology, University of South Florida Morsani College of Medicine and Tampa General Hospital, Tampa, FL (B.H.)
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Mahmud R, Sanchez-Quintana D, Macias Y, de Almeida MC, Anderson RH, Back Sternick E. To the Editor-Electrical impulse conduction through superior septal connections as a mechanism to bundle branch block correction is a verifiable assumption. Heart Rhythm 2024; 21:1449-1450. [PMID: 38508297 DOI: 10.1016/j.hrthm.2024.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/03/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Rehan Mahmud
- Department of Cardiac Electrophysiology, McLaren Bay Region, Bay City, Michigan
| | - Damian Sanchez-Quintana
- Department of Human Anatomy and Cell Biology, Faculty of Medicine, University of Extremadura, Badajoz, Spain
| | - Yolanda Macias
- Department of Medical and Surgical Therapeutics, Faculty of Veterinary, University of Extremadura, Caceres, Spain
| | - Marcos Célio de Almeida
- Department of Genetics and Morphology, University of Brasilia, Campus Asa Norte, Brasilia, Brazil
| | - Robert H Anderson
- Biosciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Eduardo Back Sternick
- Department of Arrhythmia and Electrophysiology, Biocor Hospital, Rede D'Or Sao Luiz, Nova Lima, Brazil.
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Nakamura K, Sasaki T, Minami K, Aoki H, Yoshimura S, Nishiuchi S, Naito S. Narrow QRS ectopy with concealed connections from a para-Hisian origin to the proximal left fascicles. J Cardiovasc Electrophysiol 2024; 35:1235-1241. [PMID: 38587994 DOI: 10.1111/jce.16262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/27/2024] [Accepted: 03/16/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Catheter ablation of ectopy originating from the vicinity of the His bundle can be challenging. METHODS AND RESULTS We report a case of a 33-year-old man with narrow QRS ectopy with preferential conduction from a para-Hisian origin to the proximal left fascicles, which was successfully eliminated by radiofrequency ablation in the right coronary cusp, guided by ultrahigh-resolution mapping of the His bundle, bundle branch, and fascicular electrograms. CONCLUSION Some narrow QRS ectopy may originate from the vicinity of the conduction system, instead of the "true" conduction system, and have concealed connections from its origin to the conduction system.
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Affiliation(s)
- Kohki Nakamura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi City, Gunma, Japan
| | - Takehito Sasaki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi City, Gunma, Japan
| | - Kentaro Minami
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Hideyuki Aoki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi City, Gunma, Japan
| | - Shingo Yoshimura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi City, Gunma, Japan
| | - Suguru Nishiuchi
- Department of Cardiology, Tenri Hospital, Tenri City, Nara, Japan
| | - Shigeto Naito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi City, Gunma, Japan
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Mahmud R, Sanchez-Quintana D, Macias Y, de Almeida MC, Anderson RH, Back Sternick E. Correction of bundle branch block by so-called nonselective His bundle pacing: The potential role of accessory connections in the ventricular septal crest. Heart Rhythm 2024; 21:647-654. [PMID: 38215806 DOI: 10.1016/j.hrthm.2024.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/30/2023] [Accepted: 01/03/2024] [Indexed: 01/14/2024]
Affiliation(s)
- Rehan Mahmud
- Cardiac Electrophysiology Department, McLaren Bay Region, Bay City, Michigan
| | - Damian Sanchez-Quintana
- Department of Human Anatomy and Cell Biology, Faculty of Medicine, University of Extremadura, Badajoz, Spain
| | - Yolanda Macias
- Department of Medical and Surgical Therapeutics, Faculty of Veterinary, University of Extremadura, Cáceres, Spain
| | - Marcos Célio de Almeida
- Department of Genetics and Morphology, University of Brasilia, Campus Asa Norte, Brasilia, Brazil
| | - Robert H Anderson
- Biosciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Eduardo Back Sternick
- Arrhythmia and Electrophysiology Department, Biocor Hospital, Rede D'Or São Luiz, Nova Lima, Brazil.
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Park S, Park JW, Choi Y. The Upper Common Pathway in Atrioventricular Nodal Reentrant Tachycardia: A Comprehensive Review of Evidence and Current Perspectives. Rev Cardiovasc Med 2024; 25:109. [PMID: 39076935 PMCID: PMC11263828 DOI: 10.31083/j.rcm2503109] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/23/2023] [Accepted: 12/01/2023] [Indexed: 07/31/2024] Open
Abstract
Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common form of paroxysmal supraventricular tachycardia, and its diagnostic and therapeutic approaches have been well-established. Traditionally, AVNRT is understood to be an intranodal reentry having two bystander pathways; the upper common pathway (UCP) which connects to the atrium and the lower common pathway which connects to the ventricle. However, the existence of the UCP remains a subject of ongoing debate. The assertion of the UCP's presence is supported by electrophysiological evidence suggesting that the atrium is not essential for the perpetuation of AVNRT. Nonetheless, numerous anatomical studies have failed to identify any structure that could be conclusively designated as the UCP. The histological and electrophysiological characteristics of the slow and fast pathways, which are the core components of AVNRT, suggest the inclusion of atrial myocardium in the reentry circuit. While clear interpretation of these discrepancies remains elusive, potential explanations may be derived from existing evidence and recent research findings concerning the actual AVNRT circuit.
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Affiliation(s)
- Soyoon Park
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 06591 Seoul, Republic of Korea
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, 06591 Seoul, Republic of Korea
| | - Jeong-Wook Park
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 06591 Seoul, Republic of Korea
| | - Young Choi
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 06591 Seoul, Republic of Korea
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, 06591 Seoul, Republic of Korea
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