Key result
A literature review of 60 papers found that the bundle of His and its left branch exhibit remarkable diversity in course, length, and position, which is essential for bundle-branch pacing.
Why the study?
Each element of the cardiac conduction system can exhibit anatomical variations, warranting a summary of knowledge on anatomical variations of the bundle of His and their clinical implications.
Knowledge of the anatomical variations of the bundle of His is crucial for optimizing bundle-branch pacing in patients with cardiac arrhythmias.
Anatomical variants warrant consideration in bundle-branch pacing; leaves open prospective outcome validation.
The cardiac conduction system (CCS) consists of the sinoatrial node, atrioventricular node, the atrioventricular bundle of His (HB), and its branches which terminate as subendocardial branches, also known as the Purkinje fibers. Each element of the CCS can exhibit anatomical variations. This review aims to summarize the current knowledge on anatomical variations of HB and its branches, together with the clinical implications of those variations. The literature search included medical articles published starting from 2015. For the analysis, 60 papers were involved. The articles came from PubMed, Google Scholar, Frontiers, Science Direct, and Web of Science. The HB relationship to the right fibrous trigone and membranous part of the interventricular septum can differ among individuals. Variations also include the ramification, i.e., the number of branches and the width, length, and even thickness of individual branches. In particular, HB and its left branch show the most remarkable diversity in the course, length, and position. The right branch of HB, which for most of its course runs in an unbranched fashion, is much less variable. Knowledge of CCS anatomical variations can be essential to understand cardiac electrophysiology better. With this knowledge, the bundle-branch pacing method can be used in patients with cardiac arrhythmias.
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Balawender et al. (2023) conducted a review in Anatomical variations of the atrioventricular bundle of His (n=60). Anatomical variations of the atrioventricular bundle of His was evaluated on Anatomical variations and clinical implications. A literature review of 60 papers found that the bundle of His and its left branch exhibit remarkable diversity in course, length, and position, which is essential for bundle-branch pacing.
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