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Review
. 2024 Nov 8:13:e20.
doi: 10.15420/aer.2024.15. eCollection 2024.

Revisiting the Atrioventricular Conduction Axis for the 21st Century

Robert H Anderson  1 , Damián Sánchez-Quintana  2 , Diane E Spicer  3 , Yolanda Macías  4 , Andrew C Cook  5 , José-Angel Cabrera  6   7 , Rehan Mahmud  8 , Eduardo Back Sternick  9 , Justin T Tretter  10   11
Affiliations
Review

Revisiting the Atrioventricular Conduction Axis for the 21st Century

Robert H Anderson et al. Arrhythm Electrophysiol Rev. .

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.

Keywords: Atrioventricular node; bundle of His; left bundle branch; right bundle branch.

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Conflict of interest statement

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

Figures

Figure 1:
Figure 1:. Location of the Conduction Axis in the Heart
Figure 2:
Figure 2:. The Attitudinal Arrangement of the Normal Atrioventricular Axis
Figure 3:
Figure 3:. Histological Sections Showing the Components of the Atrioventricular Axis
Figure 4:
Figure 4:. Location and Ramifications of the Left Bundle Branch
Figure 5:
Figure 5:. Histological Arrangement of Fasciculoventricular Pathways
Figure 6:
Figure 6:. Embryological Formation of the Ventricular Components of the Conduction Axis
Figure 7:
Figure 7:. Conduction Axis in the Canine Heart.
Figure 8:
Figure 8:. Conduction Axis in an Adult Mouse Heart
See this image and copyright information in PMC

References

    1. Sánchez-Quintana D, Cook AC, Macías Y et al. The atrioventricular conduction axis revisited for the 21st century. J Cardiovasc Dev Dis. 2023;10:471. doi: 10.3390/jcdd10110471. - DOI - PMC - PubMed
    1. Vijayaraman P, Chung MK, Dandamudi G et al. His bundle pacing. J Am Coll Cardiol. 2018;72:927–47. doi: 10.1016/j.jacc.2018.06.017. - DOI - PubMed
    1. His W Jr. Die Thatigkeit des embryonalen Herzens und deren Bedeutung für die Lehre von der Herzbewegung beim Erwachsenen. Arb Med Klin Leipzig. 1893;1:14–49.
    1. Tawara S. Jena: Gustav Fischer, 1906: Das Reizleitungssystem des Säugetierherzens: eine anatomisch-histologische Studie über das Atrioventrikularbundel und die Purkinjeschen Fäden.
    1. McAlpine WA. Berlin, Heidelberg: Springer, 1975;34–35.: Heart and Coronary Arteries. - DOI

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