Browse by author
Lookup NU author(s): Professor Bob Anderson
Full text for this publication is not currently held within this repository. Alternative links are provided below where available.
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. BACKGROUND: It is almost 100 years ago since Mahaim described the so-called paraspecific connections between the ventricular conduction axis and the crest of the muscular ventricular septum, believing such pathways to be ubiquitous. These pathways, however, have yet to be considered as potential pathways for septal activation during His bundle pacing. MATERIALS: So as to explore the hypothesis that specialised septal pathways might provide the substrate for septal activation during His bundle pacing, we compared the findings from 22 serially sectioned histological datasets and 34 different individuals undergoing His bundle pacing. RESULTS: We found histologically specialised pathways connecting the branching component of the atrioventricular conduction axis with the crest of the muscular ventricular septum in almost four-fifths of the histological datasets. In 32 of 34 patients undergoing His bundle pacing, the QRS complex closely resembled published images of known conduction through fasciculo-ventricular pathways. In only two patients was a delta wave not seen at any pacing voltages. Capture of these connections varied according to pacing voltage, a finding which correlated with the distance of the pathways from the site of penetration of the ventricular conduction axis. Ventricular activation times remained normal in the presence of the delta wave at higher pacing voltage but were prolonged at lower voltages. CONCLUSIONS: Our histologic findings confirm fasciculo-ventricular connections, initially described by Mahaim as being paraspecific, are likely ubiquitous. Analysis of 12-lead electrocardiograms leads us to conclude that fasciculo-ventricular pathways, concealed during sinus rhythm, become manifest with His bundle pacing.
Author(s): Mahmud R, Sternick EB, Sanchez-Quintana D, Macias Y, Jamal SM, Bailey B, Mohan A, Lee MT, Lee JE, de Almeida MC, Anderson RH
Publication type: Article
Publication status: Published
Journal: Europace
Year: 2023
Volume: 25
Issue: 5
Print publication date: 01/05/2023
Online publication date: 22/03/2023
Acceptance date: 01/02/2023
ISSN (print): 1099-5129
ISSN (electronic): 1532-2092
Publisher: Oxford University Press
URL: https://doi.org/10.1093/europace/euad050
DOI: 10.1093/europace/euad050
PubMed id: 36947460
Altmetrics provided by Altmetric
