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

Abstract 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 ‘paraspecifi...

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Bibliographic Details
Published in:Europace (London, England) England), 2022-03, Vol.24 (3), p.464-472
Main Authors: Macías, Yolanda, Tretter, Justin T, Anderson, Robert H, Sánchez-Quintana, Damián, Soares Correa, Frederico, Farré, Jerónimo, Back Sternick, Eduardo
Format: Article
Language:English
Subjects:
Adult
Atrioventricular Node
Heart Conduction System
Heart Rate
Heart Ventricles
Humans
Pre-Excitation Syndromes
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Summary:Abstract 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.
ISSN:1099-5129
1532-2092
DOI:10.1093/europace/euab286