Why the study?
Extensive anatomical knowledge and understanding of inter-individual variability of the atrioventricular conduction axis are critical to overcome technical difficulties in achieving stable lead positioning during permanent physiological pacing.
Key points are not available for this paper at this time.
Design
Review
May inform lead placement in physiological pacing; leaves open prospective outcome validation.
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.
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Cabrera et al. (2021) studied this question.
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