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The atrioventricular conduction axis and its implications for permanent pacing

Lookup NU author(s): Professor Bob Anderson



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


© 2021 Radcliffe Group Ltd. All rights reserved.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.

Publication metadata

Author(s): Cabrera J-A, Anderson RH, Porta-Sanchez A, Macias Y, Cano O, Spicer DE, Sanchez-Quintana D

Publication type: Article

Publication status: Published

Journal: Arrhythmia and Electrophysiology Review

Year: 2021

Volume: 10

Issue: 3

Pages: 181-189

Online publication date: 27/10/2021

Acceptance date: 04/08/2021

Date deposited: 06/11/2023

ISSN (print): 2050-3369

ISSN (electronic): 2050-3377

Publisher: Radcliffe Medical Media


DOI: 10.15420/aer.2021.32


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