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Miniseries 1 - Part IV: How frequent are fasciculo-ventricular connections in the normal heart?

Lookup NU author(s): Professor Bob Anderson


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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2022. For permissions, please email: AIMS: Seeking to account for accessory atrioventricular conduction potentially leading to ventricular pre-excitation, Mahaim in the mid-20th century had described pathways between the atrioventricular conduction axis and the muscular ventricular septum. We aimed to look for such 'paraspecific' connections in adult human hearts. METHODS AND RESULTS: We serially sectioned 21 hearts, covering the triangle of Koch and the aortic root, and assessing the atrioventricular node, the penetration of the conduction axis, and the bundle branches in our search for fasciculo-ventricular connections. We also calculated the length of the non-branching bundle, and if present the origin of the fasciculo-ventricular connections. The non-branching bundle was 3.6 ± 1.7 mmin length, varying from 1.7 mm to 7.2 mm. Fasciculo-ventricular connections were found in more than half of the hearts, making direct contact with the muscular septum at an average of 3.5 ± 1.7 mm from the origin of the left bundle branch, with the site of origin varying from 1.1 mm to 5.5 mm from the first fascicle of the left bundle branch. In three hearts, additional fasciculo-fascicular connections were observed in the left bundle branch. Two loops were small, but one loop extended over 9.5 mm. CONCLUSION: We endorse the finding of Mahaim that fasciculo-ventricular pathways exist in most human hearts. We presume the identified connections had the capability of producing ventricular pre-excitation. More studies are needed to determine the potential clinical manifestations.

Publication metadata

Author(s): Macias Y, Tretter JT, Anderson RH, Sanchez-Quintana D, Soares Correa F, Farre J, Back Sternick E

Publication type: Article

Publication status: Published

Journal: EP Europace

Year: 2022

Volume: 24

Issue: 3

Pages: 464-472

Print publication date: 01/03/2022

Online publication date: 06/01/2022

Acceptance date: 02/11/2021

ISSN (print): 1099-5129

ISSN (electronic): 1532-2092

Publisher: Oxford University Press


DOI: 10.1093/europace/euab286

PubMed id: 34999781


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