1
|
Sanchez-Quintana D, Cook AC, Macias Y, Spicer DE, Anderson RH. The Atrioventricular Conduction Axis Revisited for the 21st Century. J Cardiovasc Dev Dis 2023; 10:471. [PMID: 37998529 PMCID: PMC10672045 DOI: 10.3390/jcdd10110471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023] Open
Abstract
Although first described in the final decade of the 19th century, the axis responsible for atrioventricular conduction has long been the source of multiple controversies. Some of these continue to reverberate. When first described by His, for example, many doubted the existence of the bundle we now name in his honour, while Kent suggested that multiple pathways crossed the atrioventricular junctions in the normal heart. It was Tawara who clarified the situation, although many of his key definitions have not universally been accepted. In key studies in the third decade of the 20th century, Mahaim then suggested the presence of ubiquitous connections that provided "paraspecific" pathways for atrioventricular conduction. In this review, we show the validity of these original investigations, based on our own experience with a large number of datasets from human hearts prepared by serial histological sectioning. Using our own reconstructions, we show how the atrioventricular conduction axis can be placed back within the heart. We emphasise that newly emerging techniques will be key in providing the resolution to map cellular detail to the gross evidence provided by the serial sections.
Collapse
Affiliation(s)
- Damian Sanchez-Quintana
- Department of Human Anatomy and Cell Biology, Faculty of Medicine, University of Extremadura, 06006 Badajoz, Spain
| | - Andrew C. Cook
- Institute of Cardiovascular Science, University College London, London WC1E 6BT, UK;
| | - Yolanda Macias
- Department of Medical and Surgical Therapeutics, Faculty of Veterinary, University of Extremadura, 10071 Cáceres, Spain;
| | - Diane E. Spicer
- Heart Institute, Johns Hopkins All Children’s Hospital, St. Petersburg, FL 33701, USA;
| | - Robert H. Anderson
- Biosciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK;
| |
Collapse
|
2
|
Pérez-Riera AR, Barbosa-Barros R, Andreou AY, Fiol-Sala M, Birnbaum Y, da Silva Rocha M, Daminello-Raimundo R, de Abreu LC, Nikus K. Left septal fascicular block: Evidence, causes, and diagnostic criteria. Heart Rhythm 2023; 20:1558-1569. [PMID: 37586583 DOI: 10.1016/j.hrthm.2023.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 08/18/2023]
Abstract
The existence of a tetrafascicular intraventricular conduction system is widely accepted by researchers. In this review, we have updated the criteria for left septal fascicular block (LSFB) and the differential diagnosis of prominent anterior QRS forces. More and more evidence points to the fact that the main cause of LSFB is critical proximal stenosis of the left anterior descending coronary artery before its first septal perforator branch. The most important characteristic of LSFB that has been incorporated in the corresponding diagnostic electrocardiographic criteria is its transient/intermittent nature mostly observed in clinical scenarios of acute (ie, acute coronary syndrome including vasospastic angina) or chronic (ie, exercise-induced ischemia) ischemic coronary artery disease. In addition, the phenomenon proved to be phase 4 bradycardia rate dependent and induced by early atrial extrastimulus. Finally, we believe that intermittent LSFB has the same clinical significance as "Wellens syndrome" and the "de Winter pattern" in the acute coronary syndrome scenario.
Collapse
Affiliation(s)
- Andrés Ricardo Pérez-Riera
- Laboratório de Metodologia de Pesquisa e Escrita Científica, Centro Universitário Saúde ABC, Santo André, São Paulo, Brazil; Clínica Médica, Universidade Uninove, Mauá, São Paulo, Brazil.
| | - Raimundo Barbosa-Barros
- Coronary Center of the Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | - Andreas Y Andreou
- Department of Cardiology, Limassol General Hospital, Limassol, Cyprus; University of Nicosia Medical School, Nicosia, Cyprus
| | - Miguel Fiol-Sala
- Balearic Islands Institute for Health Research, Hospital Son Espases, Palma de Mallorca, Spain
| | - Yochai Birnbaum
- Department of Medicine Cardiology, Baylor College of Medicine, Houston, Texas
| | | | - Rodrigo Daminello-Raimundo
- Laboratório de Metodologia de Pesquisa e Escrita Científica, Centro Universitário Saúde ABC, Santo André, São Paulo, Brazil
| | - Luiz Carlos de Abreu
- Laboratório de Metodologia de Pesquisa e Escrita Científica, Centro Universitário Saúde ABC, Santo André, São Paulo, Brazil; Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Kjell Nikus
- Heart Center, Tampere University Hospital, Tampere, Finland; Faculty of Medicine, Tampere University, Tampere, Finland
| |
Collapse
|
3
|
Gómez-Torres F, Ballesteros-Acuña L, Ruíz-Sauri A. Histopathological changes in the electrical conduction of cardiac nodes after acute myocardial infarction in dogs and horses, compared with findings in humans: A histological, morphometrical, and immunohistochemical study. Vet World 2023; 16:2173-2185. [PMID: 38023272 PMCID: PMC10668561 DOI: 10.14202/vetworld.2023.2173-2185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/14/2023] [Indexed: 12/01/2023] Open
Abstract
Background and Aim The heart conduction system is responsible for the occurrence of various types of cardiac arrhythmia. This study aimed to histologically and morphometrically describe damaged cardiac nodes during acute myocardial infarction and to compare them with normal tissues in dogs and horses. Materials and Methods This study describes the morphometry of cardiac nodes in five dogs and five elderly horses that succumbed to sudden cardiac death (SCD). A computerized morphometric study was conducted to determine the number of cells composing the nodes, different shape and size parameters of nodes, and their relationship with degenerative changes due to cardiac conditions. Results In both species, the sinoatrial node (SAN) was ovoid in shape whereas the atrioventricular node (AVN) was pyramidal in shape. The percentage of collagen fibers inside the SAN of dogs (47%) and horses (50%) was found to be higher than that of cells. In contrast, the percentage of cells in the AVN of dogs (24%) and horses (16%) was higher than that of connective tissues. In the SAN, the area (p = 0.09), maximum diameter (<0.001), and mean diameter (0.003) of P cells were larger in dogs than in horses. Conclusion Overall, the SAN cells and surrounding cardiomyocytes in dogs and horses as well as the AVN cells in dogs that succumbed to SCD decreased in size compared with those in normal hearts.
Collapse
Affiliation(s)
- Fabián Gómez-Torres
- Department of Basic Sciences, School of Medicine, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Luis Ballesteros-Acuña
- Department of Basic Sciences, School of Medicine, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Amparo Ruíz-Sauri
- Department of Pathology, Faculty of Medicine, Universitat de Valencia, Valencia, Spain
- INCLIVA Biomedical Research Institute, Valencia, Spain
| |
Collapse
|
4
|
Iwanaga J, Manoharan S, Cardona JJ, Anadkat S, Saga T, Loukas M, Tubbs RS. Anatomical Study of the Atrioventricular Nodal Branch of the Heart. Cureus 2023; 15:e35412. [PMID: 36994300 PMCID: PMC10042528 DOI: 10.7759/cureus.35412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 02/26/2023] Open
Abstract
Background The atrioventricular (AV) node is a relay station for electrical signals passing between the atria and ventricles. The artery supplying the AV node is functionally important, and its anatomical topography is relevant during invasive procedures. Therefore, the aim of this study was to identify and understand the variations of the origin of the AV nodal branch (AVNb) and its variations. Materials and methods We dissected 31 adult human hearts to evaluate their AVNb and its variations. A classification scheme was used to detail the morphology found for each of these arteries. Results We identified five distinct origins of the AVNb: AVNb originating from the right coronary artery (RCA) proximal to the inferior interventricular branch (IVb) (type I, 3.2%), AVNb originating from the junction of the RCA and IVb (type II, 19.4%), AVNb originating from the RCA distal to the IVb (type III, 64.5%), AVNb originating from the IVb (type IV, 6.5%), and AVNb originating from the circumflex branch of the left coronary artery (LCA) (type V, 6.5%). Conclusions Our study provides data on the morphology and variations of the AVNb. Such information can assist in better diagnoses based on imaging, better guide invasive procedures, and provide the cardiac surgeon with an improved method of classifying the AVNb and its branches during procedures of the coronary arteries and their branches.
Collapse
|
5
|
Best A, Egerbacher M, Swaine S, Pérez W, Alibhai A, Rutland P, Kubale V, El‐Gendy SAA, Alsafy MAM, Baiker K, Sturrock CJ, Rutland CS. Anatomy, histology, development and functions of Ossa cordis: A review. Anat Histol Embryol 2022; 51:683-695. [PMID: 36073246 PMCID: PMC9826330 DOI: 10.1111/ahe.12861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/15/2022] [Accepted: 08/25/2022] [Indexed: 01/12/2023]
Abstract
This systematic review highlights the similarities and variations in Ossa cordis prevalence, histology and anatomical location between differing veterinary species and in humans. In addition, it also identifies associated factors such as aging and cardiovascular disease for each species in relation to functional roles and developmental mechanisms that these bone structures may play. The potential functions of Ossa cordis are presented, ranging from aiding cardiac contraction and conduction, providing cardiac structure, and protecting components of the heart, through to counteracting high mechanical stress. Furthermore, this review discusses the evidence and rationale behind the theories regarding the formation and development of Ossa cordis in different veterinary species and in people.
Collapse
Affiliation(s)
- Adam Best
- School of Veterinary Medicine and ScienceFaculty of Medicine and Health Science, University of NottinghamLeicestershireUK
| | - Monika Egerbacher
- Admin. Unit of Veterinary MedicineUMIT TIROL – Private University for Health Sciences, Medical Informatics and TechnologyHall in TirolTyrolAustria
| | - Sophia Swaine
- School of Veterinary Medicine and ScienceFaculty of Medicine and Health Science, University of NottinghamLeicestershireUK
| | - William Pérez
- Unidad de Anatomía, Facultad de VeterinariaUniversidad de la RepúblicaMontevideoUruguay
| | - Aziza Alibhai
- School of Veterinary Medicine and ScienceFaculty of Medicine and Health Science, University of NottinghamLeicestershireUK
| | - Paul Rutland
- University College LondonGreat Ormond Street Institute of Child HealthLondonUK
| | - Valentina Kubale
- Veterinary Faculty, Institute of Preclinical SciencesUniversity of LjubljanaLjubjanaSlovenia
| | - Samir A. A. El‐Gendy
- Department of Anatomy and EmbryologyFaculty of Veterinary Medicine, Alexandria UniversityEgypt
| | - Mohamed A. M. Alsafy
- Department of Anatomy and EmbryologyFaculty of Veterinary Medicine, Alexandria UniversityEgypt
| | - Kerstin Baiker
- School of Veterinary Medicine and ScienceFaculty of Medicine and Health Science, University of NottinghamLeicestershireUK
| | - Craig J. Sturrock
- The Hounsfield Facility, School of BiosciencesUniversity of NottinghamLeicestershireUK
| | - Catrin Sian Rutland
- School of Veterinary Medicine and ScienceFaculty of Medicine and Health Science, University of NottinghamLeicestershireUK
| |
Collapse
|
6
|
Macías Y, de Almeida MC, Tretter JT, Anderson RH, Spicer DE, Mohun TJ, Sánchez-Quintana D, Farré J, Back Sternick E. Miniseries 1-Part II: the comparative anatomy of the atrioventricular conduction axis. Europace 2022; 24:443-454. [PMID: 34999788 DOI: 10.1093/europace/euab291] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/08/2021] [Indexed: 12/14/2022] Open
Abstract
AIMS The arrangement of the conduction axis is markedly different in various mammalian species. Knowledge of such variation may serve to question the validity of using animals as prospective models for design of systems for clinical use. METHODS AND RESULTS We compared the arrangement of the atrioventricular conduction axis in human, murine, canine, porcine, and bovine hearts, examining serially sectioned datasets from 20 human, 16 murine, 3 porcine, 5 canine, and 1 bovine hearts. We also analysed computed tomographic datasets obtained from bovines and one human heart. Unlike the situation in the human heart, there is no formation of an atrioventricular fibrous membranous septum in the murine, canine, porcine, nor bovine hearts. Canine, porcine, and bovine hearts also lack an infero-septal recess, when defined as a fibrous plate supporting the buttress of the atrial septum. In these species, half of the non-coronary leaflet is directly opposed to the ventricular septal surface. CONCLUSION There is a long right-sided non-branching component of the axis, which skirts the attachment of the non-coronary sinus of the aortic root. In the bovine heart, moreover, the left bundle branch usually extends intramyocardially as a solitary tape before surfacing and ramifying on the left ventricular septal surface. The difference in the atrioventricular conduction axis between species may influence the anatomical substrates for atrioventricular re-entry tachycardia, as well as providing inferences for assessing the risks of transcatheter implantation of the aortic valve. Further studies are now needed to assess these possibilities.
Collapse
Affiliation(s)
- Yolanda Macías
- Department of Medical and Surgical Therapeutics, Veterinary Faculty, University of Extremadura, Cáceres, Spain
| | - Marcos C de Almeida
- Department of Genetics and Morphology, Brasilia's University, Campus Asa Norte, Brasilia, Brazil
| | - Justin T Tretter
- Department of Pediatrics, Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Robert H Anderson
- Biosciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Diane E Spicer
- Congenital Heart Center, University of Florida, Gainesville, FL, USA
| | - Timothy J Mohun
- The Francis Crick Institute, 1 Midland Road, London NW1 1AT, UK
| | - Damián Sánchez-Quintana
- Department of Human Anatomy and Cell Biology, Faculty of Medicine, University of Extremadura, Badajoz, Spain
| | - Jerónimo Farré
- Fundación Jiménez Díaz University Hospital, Institute of Biomedical Research, Madrid, Spain
| | - Eduardo Back Sternick
- Arrhythmia and Electrophysiology Unit, Biocor Institute, Nova Lima, Minas Gerais, Brazil
| |
Collapse
|
7
|
Gómez-Torres F, Ruíz-Sauri A. Morphometric analysis of the His bundle (atrioventricular fascicle) in humans and other animal species. Histological and immunohistochemical study. Vet Res Commun 2021; 45:319-327. [PMID: 34244914 DOI: 10.1007/s11259-021-09812-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
The His bundle is a part of the specialized electrical conduction system that provides a connection between the atrial and ventricular myocardial compartments in both normal and abnormal hearts. The aim of this study was to perform a morphometric analysis of His bundle characteristics of in humans, dogs, horses and pigs and compare them in these studied species. Histological sections of 5 μm thickness were obtained and stained with hematoxylin-eosin and Masson's trichrome; the desmin and periodic acid-Schiff methods were also used for precise identification of cells. The His bundle was found to be longer in horses (2.85 ± 1.02 mm) and pigs (1.77 ± 0.9 mm) than in dogs (1.53 ± 0.8 mm) or humans, in which it was shortest (1.06 ± 0.6 mm). The area and diameters in His bundle cells, were significantly larger in pigs and horses than in humans (p < 0.001) or dogs (p < 0.001). We found two organizational patterns of His bundle components: group I, with large cells and a high amount of collagen fibers in ungulates (pigs and horses); and group II, with smaller cells and lower abundance of collagen fibers in humans and dogs. Documenting cell size variations in the His bundle allows us not only to identify this bundle by histological or anatomical location but also to differentiate these cells from others such as nodal or Purkinje cells. Our analysis revealed that His bundle cells have discrete identities based on their morphometric and histological characteristics.
Collapse
Affiliation(s)
- Fabián Gómez-Torres
- Department of Pathology, Faculty of Medicine, Universitat de Valencia, 1st floor, Av. de Blasco Ibáñez, 15, 46010, Valencia, Spain.,Department of Basic Sciences, School of Medicine, Universidad Industrial de Santander, Cra, 32 # 29-31, 68002, Bucaramanga, Colombia
| | - Amparo Ruíz-Sauri
- Department of Pathology, Faculty of Medicine, Universitat de Valencia, 1st floor, Av. de Blasco Ibáñez, 15, 46010, Valencia, Spain. .,INCLIVA Biomedical Research Institute, Av. de Blasco Ibáñez, 17, 46010, Valencia, Spain.
| |
Collapse
|
8
|
De Almeida MC, Mori S, Anderson RH. Three-dimensional visualization of the bovine cardiac conduction system and surrounding structures compared to the arrangements in the human heart. J Anat 2021; 238:1359-1370. [PMID: 33491213 DOI: 10.1111/joa.13397] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/10/2020] [Accepted: 01/05/2021] [Indexed: 12/14/2022] Open
Abstract
In the human heart, the atrioventricular node is located toward the apex of the triangle of Koch, which is also at the apex of the inferior pyramidal space. It is adjacent to the atrioventricular portion of the membranous septum, through which it penetrates to become the atrioventricular bundle. Subsequent to its penetration, the conduction axis is located on the crest of the ventricular septum, sandwiched between the muscular septum and ventricular component of the membranous septum, where it gives rise to the ramifications of the left bundle branch. In contrast, the bovine conduction axis has a long non-branching component, which penetrates into a thick muscular atrioventricular septum having skirted the main cardiac bone and the rightward half of the non-coronary sinus of the aortic root. It commonly gives rise to both right and left bundle branches within the muscular ventricular septum. Unlike the situation in man, the left bundle branch is long and thin before it branches into its fascicles. These differences from the human heart, however, have yet to be shown in three-dimensions relative to the surrounding structures. We have now achieved this goal by injecting contrast material into the insulating sheaths that surround the conduction network, evaluating the results by subsequent computed tomography. The fibrous atrioventricular membranous septum of the human heart is replaced in the ox by the main cardiac bone and the muscular atrioventricular septum. The apex of the inferior pyramidal space, which in the bovine, as in the human, is related to the atrioventricular node, is placed inferiorly relative to the left ventricular outflow tract. The bovine atrioventricular conduction axis, therefore, originates from a node itself located inferiorly compared to the human arrangement. The axis must then skirt the non-coronary sinus of the aortic root prior to penetrating the thicker muscular ventricular septum, thus accounting for its long non-branching course. We envisage that our findings will further enhance comparative anatomical research.
Collapse
Affiliation(s)
- Marcos C De Almeida
- Department of Genetics and Morphology, Brasilia's University, Brasilia, Brazil
| | - Shumpei Mori
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Robert H Anderson
- Biosciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| |
Collapse
|