Synchronous ventricular pacing with direct capture of the atrioventricular conduction system

Functional anatomy, terminology, and challenges

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Right ventricular apical pacing is associated with an increased incidence of heart failure, atrial fibrillation, and overall mortality. As a result, pacing the ventricles in a manner that closely mimics normal AV conduction with an intact His–Purkinje system has been explored. Recently, the sustainable benefits of selective His-bundle stimulation have been demonstrated and proposed as the preferred method of ventricular stimulation for appropriate patients. Ideally, conduction system pacing should be selective without myocardial capture, overcome distal bundle branch block when present, and not compromise tricuspid valve function. Contemporary literature on conduction system pacing is confusing largely because of inconsistent terminology and, at times, anatomically inaccurate terms used interchangeably for nonsynonymous anatomic sites. In this review, we discuss the functional anatomy of AV conduction access with specific emphasis on terminology, relationship to the membranous septum, tricuspid valve tissue, and proximity to atrial or ventricular myocardium. The potential benefits of each specific site as well as associated unique difficulties with those sites are described.

Original languageEnglish (US)
Pages (from-to)2237-2246
Number of pages10
JournalHeart Rhythm
Volume13
Issue number11
DOIs
StatePublished - Nov 1 2016

Fingerprint

Tricuspid Valve
Terminology
Anatomy
Literature
Bundle of His
Bundle-Branch Block
Atrial Fibrillation
Myocardium
Heart Failure
Mortality
Incidence

Keywords

  • Atrioventricular node
  • Cardiac pacing
  • Conduction system
  • His bundle
  • Ventricular synchrony

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

@article{bef6af0f985b40e9b21edd5a49f49ffd,
title = "Synchronous ventricular pacing with direct capture of the atrioventricular conduction system: Functional anatomy, terminology, and challenges",
abstract = "Right ventricular apical pacing is associated with an increased incidence of heart failure, atrial fibrillation, and overall mortality. As a result, pacing the ventricles in a manner that closely mimics normal AV conduction with an intact His–Purkinje system has been explored. Recently, the sustainable benefits of selective His-bundle stimulation have been demonstrated and proposed as the preferred method of ventricular stimulation for appropriate patients. Ideally, conduction system pacing should be selective without myocardial capture, overcome distal bundle branch block when present, and not compromise tricuspid valve function. Contemporary literature on conduction system pacing is confusing largely because of inconsistent terminology and, at times, anatomically inaccurate terms used interchangeably for nonsynonymous anatomic sites. In this review, we discuss the functional anatomy of AV conduction access with specific emphasis on terminology, relationship to the membranous septum, tricuspid valve tissue, and proximity to atrial or ventricular myocardium. The potential benefits of each specific site as well as associated unique difficulties with those sites are described.",
keywords = "Atrioventricular node, Cardiac pacing, Conduction system, His bundle, Ventricular synchrony",
author = "Siva Mulpuru and Yong-Mei Cha and Asirvatham, {Samuel J}",
year = "2016",
month = "11",
day = "1",
doi = "10.1016/j.hrthm.2016.08.005",
language = "English (US)",
volume = "13",
pages = "2237--2246",
journal = "Heart Rhythm",
issn = "1547-5271",
publisher = "Elsevier",
number = "11",

}

TY - JOUR

T1 - Synchronous ventricular pacing with direct capture of the atrioventricular conduction system

T2 - Functional anatomy, terminology, and challenges

AU - Mulpuru, Siva

AU - Cha, Yong-Mei

AU - Asirvatham, Samuel J

PY - 2016/11/1

Y1 - 2016/11/1

N2 - Right ventricular apical pacing is associated with an increased incidence of heart failure, atrial fibrillation, and overall mortality. As a result, pacing the ventricles in a manner that closely mimics normal AV conduction with an intact His–Purkinje system has been explored. Recently, the sustainable benefits of selective His-bundle stimulation have been demonstrated and proposed as the preferred method of ventricular stimulation for appropriate patients. Ideally, conduction system pacing should be selective without myocardial capture, overcome distal bundle branch block when present, and not compromise tricuspid valve function. Contemporary literature on conduction system pacing is confusing largely because of inconsistent terminology and, at times, anatomically inaccurate terms used interchangeably for nonsynonymous anatomic sites. In this review, we discuss the functional anatomy of AV conduction access with specific emphasis on terminology, relationship to the membranous septum, tricuspid valve tissue, and proximity to atrial or ventricular myocardium. The potential benefits of each specific site as well as associated unique difficulties with those sites are described.

AB - Right ventricular apical pacing is associated with an increased incidence of heart failure, atrial fibrillation, and overall mortality. As a result, pacing the ventricles in a manner that closely mimics normal AV conduction with an intact His–Purkinje system has been explored. Recently, the sustainable benefits of selective His-bundle stimulation have been demonstrated and proposed as the preferred method of ventricular stimulation for appropriate patients. Ideally, conduction system pacing should be selective without myocardial capture, overcome distal bundle branch block when present, and not compromise tricuspid valve function. Contemporary literature on conduction system pacing is confusing largely because of inconsistent terminology and, at times, anatomically inaccurate terms used interchangeably for nonsynonymous anatomic sites. In this review, we discuss the functional anatomy of AV conduction access with specific emphasis on terminology, relationship to the membranous septum, tricuspid valve tissue, and proximity to atrial or ventricular myocardium. The potential benefits of each specific site as well as associated unique difficulties with those sites are described.

KW - Atrioventricular node

KW - Cardiac pacing

KW - Conduction system

KW - His bundle

KW - Ventricular synchrony

UR - http://www.scopus.com/inward/record.url?scp=84992641069&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84992641069&partnerID=8YFLogxK

U2 - 10.1016/j.hrthm.2016.08.005

DO - 10.1016/j.hrthm.2016.08.005

M3 - Article

VL - 13

SP - 2237

EP - 2246

JO - Heart Rhythm

JF - Heart Rhythm

SN - 1547-5271

IS - 11

ER -