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Review
. 2021 Oct;10(3):181-189.
doi: 10.15420/aer.2021.32.

The Atrioventricular Conduction Axis and its Implications for Permanent Pacing

José-Ángel Cabrera  1 , Robert H Anderson  2 , Andreu Porta-Sánchez  1   3 , Yolanda Macías  4 , Óscar Cano  5 , Diane E Spicer  6 , Damián Sánchez-Quintana  7
Affiliations
Review

The Atrioventricular Conduction Axis and its Implications for Permanent Pacing

José-Ángel Cabrera et al. Arrhythm Electrophysiol Rev. 2021 Oct.

Abstract

Extensive knowledge of the anatomy of the atrioventricular conduction axis, and its branches, is key to the success of permanent physiological pacing, either by capturing the His bundle, the left bundle branch or the adjacent septal regions. The inter-individual variability of the axis plays an important role in underscoring the technical difficulties known to exist in achieving a stable position of the stimulating leads. In this review, the key anatomical features of the location of the axis relative to the triangle of Koch, the aortic root, the inferior pyramidal space and the inferoseptal recess are summarised. In keeping with the increasing number of implants aimed at targeting the environs of the left bundle branch, an extensive review of the known variability in the pattern of ramification of the left bundle branch from the axis is included. This permits the authors to summarise in a pragmatic fashion the most relevant aspects to be taken into account when seeking to successfully deploy a permanent pacing lead.

Keywords: His bundle; His pacing; conduction axis pacing; inferior pyramidal space; inferoseptal recess; left bundle branch; penetrating atrioventricular bundle.

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Conflict of interest statement

Disclosure: RHA is on the Arrhythmia & Electrophysiology Review editorial board; this did not influence peer review. All other authors have no conflicts of interest to declare.

Figures

Figure 1:
Figure 1:. Human Atrioventricular Axis
Figure 2:
Figure 2:. Triangle of Koch, Inferoseptal Recess and Inferior Pyramidal Space
Figure 3:
Figure 3:. Inferior Pyramidal Space
Figure 4:
Figure 4:. Atrio and Interventricular Membranous Septum
Figure 5:
Figure 5:. Atrioventricular Node
Figure 6:
Figure 6:. Variable Location of the Atrioventricular Node and the Penetrating Bundle
Figure 7:
Figure 7:. Area of His and the Left Bundle Branch Pacing
Figure 8:
Figure 8:. Subaortic Outflow Tract and the Crest of the Muscular Septum
Figure 9:
Figure 9:. Left Bundle Branch
Figure 10:
Figure 10:. Angiographic Anatomy for Left Bundle Branch Pacing
See this image and copyright information in PMC

References

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