Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-5f745c7db-nc56l Total loading time: 0 Render date: 2025-01-07T04:59:46.430Z Has data issue: true hasContentIssue false

Chapter 6 - Surgical Anatomy of Cardiac Conduction

Published online by Cambridge University Press:  10 April 2024

Robert H. Anderson ,
Andrew C. Cook ,
Diane E. Spicer ,
Anthony M. Hlavacek ,
Carl L. Backer  and
Justin T. Tretter
Robert H. Anderson
Affiliation:
Institute of Genetic Medicine, Newcastle University
Andrew C. Cook
Affiliation:
University College London
Diane E. Spicer
Affiliation:
University of Florida
Anthony M. Hlavacek
Affiliation:
Medical University of South Carolina
Carl L. Backer
Affiliation:
Cincinnati Children's Hospital
Justin T. Tretter
Affiliation:
Cleveland Clinic, Ohio
Get access

Summary

The disposition of the conduction system in the normal heart has already been emphasized (see Chapter 2). In that earlier chapter, we pointed to the importance, during surgical procedures, of avoiding the cardiac nodes and ventricular bundle branches, and scrupulously protecting the vascular supply to these structures. In this chapter, we will consider the anatomy of these tissues relative to the treatment of intractable problems of cardiac rhythm, specifically the normal and abnormal atrioventricular conduction axis. The abnormal dispositions of the conduction tissues to be found in congenitally malformed hearts, features of obvious significance to the congenital cardiac surgeon, will be discussed in the sections devoted to those lesions in the chapters that follow. In this chapter, nonetheless, we will also discuss surgical procedures performed to treat arrhythmias that develop in the setting of the Fontan circulation.

Type
Chapter
Information
Wilcox's Surgical Anatomy of the Heart , pp. 133 - 152
Publisher: Cambridge University Press
Print publication year: 2024

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

References Cited

Cabrera, JÁ, Anderson, RH, Macías, Y, et al. Variable arrangement of the atrioventricular conduction axis within the triangle of Koch: implications for permanent His bundle pacing. Clin Electrophysiol 2020; 6: 362–377.CrossRefGoogle ScholarPubMed
Macías, Y, Tretter, JT, Sánchez‐Quintana, D, et al. The atrioventricular conduction axis and the aortic root – inferences for transcatheter replacement of the aortic valve. Clinical Anatomy 2022; 35: 143–154.CrossRefGoogle ScholarPubMed
Massing, GK, James, TN. Anatomical configuration of the His bundle and bundle branches in the human heart. Circulation 1976; 53: 609–621.CrossRefGoogle ScholarPubMed
Tretter, JT, Spicer, DE, Macías, Y, et al. Vulnerability of the ventricular conduction axis during transcatheter aortic valvar implantation: a translational pathologic study. Clin Anat 2023; 36: 836–846.CrossRefGoogle ScholarPubMed
Anderson, RH, Spicer, DE, Mori, S. Of tracts, rings, nodes, cusps, sinuses, and arrhythmias – a comment on Szili-Torok et al.’s paper entitled ‘The “Dead-End Tract” and Its Role in Arrhythmogenesis’. J Cardiovasc Dev Dis 2016; 3: 11.Google Scholar
Anderson, RH, Sanchez-Quintana, D, Mori, S, Cabrera, JA, Back Sternick, E. Re-evaluation of the structure of the atrioventricular node and its connections with the atrium. EP Europace 2020; 22: 821–830.CrossRefGoogle ScholarPubMed
Durrer, D, Schuilenburg, RM, Wellens, HJJ. Pre-excitation revisited. Am J Cardiol 1970; 25: 690–698.CrossRefGoogle ScholarPubMed
Mahaim, I. Maladies organiques du faisceau de His-Tawara. Paris: Masson et Cie; 1931.Google Scholar
Sternick, EB, Sanchez-Quintana, D, Wellens, HJ, Anderson, RH. revisited, Mahaim. Arrhythmia Electrophysiol Rev 2022; 11: e14.CrossRefGoogle Scholar
Cabrera, JÁ, Anderson, RH, Porta-Sánchez, A, et al. The atrioventricular conduction axis and its implications for permanent pacing. Arrhythmia Electrophysiol Rev 2021; 10: 181.CrossRefGoogle ScholarPubMed
Sealy, WC, Gallagher, JJ, Pritchett, ELC. The surgical anatomy of Kent bundles based on electrophysiological mapping and surgical exploration. J Thorac Cardiovasc Surg 1978; 76: 804–815.CrossRefGoogle ScholarPubMed
Ohnell, RF. Preexcitation, a cardiac abnormality. Pathophysiological, patho-anatomical and clinical studies of an excitatory spread phenomenon. Acta Med Scand 1944; 152 (Suppl.1): 167.Google Scholar
Anderson, RH, Davies, MJ, Becker, AE. Atrioventricular ring specialized tissue in the normal heart. Eur J Cardiol 1974; 2: 219–230.Google Scholar
Becker, AE, Anderson, RH, Durrer, D, Wellens, HJJ. The anatomical substrates of Wolff-Parkinson-White syndrome. A clinicopathologic correlation in seven patients. Circulation 1978; 57: 870–879.CrossRefGoogle ScholarPubMed
Sealy, WC, Gallagher, JJ. The surgical approach to the septal area of the heart based on experience with 45 patients with Kent bundles. J Thorac Cardiovasc Surg 1980; 79: 542–551.CrossRefGoogle Scholar
Tretter, JT, Spicer, DE, Sánchez-Quintana, D, et al. Miniseries 1 – part III: ‘behind the scenes’ in the triangle of Koch. EP Europace 2022; 24: 455–463.CrossRefGoogle ScholarPubMed
Johnson, DC, Ross, DL, Uther, JB. The surgical cure of atrioventricular junctional reentrant tachycardia. In DP Zipes, , J Jalife, , eds., Cardiac Electrophysiology from Cell to Bedside. London: W.B. Saunders; 1990: pp. 921–923.Google Scholar
Guiraudon, GM, Klein, GJ, Sharma, AD, et al. Surgical approach to anterior septal accessory pathways in 20 patients with the Wolff-Parkinson-White syndrome. Eur J Cardio-thorac Surg 1988; 2: 201–206.CrossRefGoogle ScholarPubMed
Anderson, RH, Sánchez‐Quintana, D, Mori, S, et al. Unusual variants of pre‐excitation: from anatomy to ablation: part I – understanding the anatomy of the variants of ventricular pre‐excitation. J Cardiovasc Electrophys 2019; 30: 2170–2180.CrossRefGoogle ScholarPubMed
Guiraudon, CM, Guiraudon, GM, Klein, GJ. ‘Nodal ventricular’ Mahaim pathway: histologic evidence for an accessory atrioventricular pathway with an AV node-like morphology. Circulation 1988; 78 (Suppl.2): 1035–1040.Google Scholar
Kent, AFS. The structure of the cardiac tissues at the auriculo-ventricular junction. J Physiol 1913; 47: 17–18.Google Scholar
Anderson, RH, Ho, SY, Gillette, PC, Becker, AE. Mahaim, Kent and abnormal atrioventricular conduction. Cardiovasc Res 1996; 31: 480–491.CrossRefGoogle ScholarPubMed
Cosio, FG, Lopez-Gil, M, Giocolea, A, Arribas, F, Barroso, JL. Radiofrequency ablation of the inferior vena cava-tricuspid valve isthmus in common atrial flutter. Am J Cardiol 1993; 71: 705–709.CrossRefGoogle ScholarPubMed
Cabrera, JA, Sanchez-Quintana, D, Ho, SY, Medina, A, Anderson, RH. The architecture of the atrial musculature between the orifice of the inferior caval vein and the tricuspid valve: the anatomy of the isthmus. J Cardiovasc Electrophysiol 1998; 9: 1186–1195.CrossRefGoogle ScholarPubMed
Mavroudis, C, Backer, CL, Deal, BJ, Johnsrude, C, Strasburger, J. Total cavopulmonary conversion and maze procedure for patients with failure of the Fontan operation. J Thorac Cardiovasc Surg 2001; 122: 863–871.CrossRefGoogle ScholarPubMed
Cox, JL, Boineau, JP, Schuessler, RB, Jaquiss, RD, Lappas, DG. Modification of the maze procedure for atrial flutter and atrial fibrillation. I. Rationale and surgical results. J Thorac Cardiovasc Surg 1995; 110: 473–484.CrossRefGoogle ScholarPubMed
Defauw, JJ, Guiraudon, GM, van Hemel, NM, et al. Surgical therapy of paroxysmal atrial fibrillation with the ‘corridor’ operation. Ann Thorac Surg 1992; 53: 564–570.CrossRefGoogle ScholarPubMed
Cox, JL, Ad, N. New surgical and catheter-based modifications of the Maze procedure. Semin Thorac Cardiovasc Surg 2000; 12: 68–73.CrossRefGoogle ScholarPubMed
Goya, M, Ouyang, F, Ernst, S, et al. Electroanatomic mapping and catheter ablation of breakthroughs from the right atrium to the superior vena cava in patients with atrial fibrillation. Circulation 2002; 106: 1317–1320.CrossRefGoogle Scholar
Pappone, C, Oreto, G, Rosanio, S, et al. Atrial electroanatomic remodelling after circumferential radiofrequency pulmonary vein ablation: efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation. Circulation 2001; 104: 2539–2544.CrossRefGoogle Scholar
Shah, DC, Haissaguerre, M, Jais, P. Catheter ablation of pulmonary vein foci for atrial fibrillation. PV foci ablation for atrial fibrillation. Thorac Cardiovasc Surgeon 1999; 47 (Suppl.3): 352–356.CrossRefGoogle ScholarPubMed
Ho, SY, Cabrera, JA, Tran, VH, et al. Architecture of the pulmonary veins: relevance to radiofrequency ablation. Heart 2001; 86: 265–270.CrossRefGoogle ScholarPubMed
Hocini, M, Ho, SY, Kawara, T, et al. Electrical conduction in canine pulmonary veins. Electrophysiological and anatomical correlation. Circulation 2002; 105: 2442–2448.CrossRefGoogle Scholar
Perez-Lugones, A, McMahan, JT, Ratliff, NB, et al. Evidence of specialized conduction cells in human pulmonary veins of patients with atrial fibrillation. J Cardiovasc Electrophysiol 2003; 14: 803–809.CrossRefGoogle ScholarPubMed
Mommersteeg, MT, Christoffels, VM, Anderson, RH, Moorman, AF. Atrial fibrillation: a developmental point of view. Heart Rhythm 2009; 6: 1818–1824.CrossRefGoogle ScholarPubMed
Anderson, RH, Mohun, TJ, Sánchez-Quintana, D, et al. The anatomic substrates for outflow tract arrhythmias. Heart Rhythm 2019; 16: 290–297.CrossRefGoogle ScholarPubMed
Cheung, JW, Anderson, RH, Markowitz, SM, Lerman, BB. Catheter ablation of arrhythmias originating from the left ventricular outflow tract. JACC Clin Electrophysiol 2019; 5: 1–2.CrossRefGoogle ScholarPubMed
Bohora, S, Lokhandwala, Y, Sternick, EB, Anderson, RH, Wellens, HJ. Reappraisal and new observations on atrial tachycardia ablated from the non-coronary aortic sinus of Valsalva. Europace 2018; 20: 124–133.CrossRefGoogle ScholarPubMed
Rosenquist, GC, Clark, EB, Sweeney, LJ, McAllister, HA. The normal spectrum of mitral and aortic valve discontinuity. Circulation 1976; 54: 298–301.CrossRefGoogle ScholarPubMed
Timmermans, C, Rodriguez, LM, Crijns, HJ, Moorman, AF, Wellens, HJ. Idiopathic left bundle-branch block-shaped ventricular tachycardia may originate above the pulmonary valve. Circulation 2003; 108: 1960–1967.CrossRefGoogle ScholarPubMed
Sizarov, A, Lamers, WH, Mohun, TJ, et al. Three-dimensional and molecular analysis of the arterial pole of the developing human heart. J Anat 2012; 220: 336–349.CrossRefGoogle ScholarPubMed
Karamlou, T, Silber, I, Lao, R, et al. Outcomes after late reoperation in patients with repaired tetralogy of Fallot: the impact of arrhythmia and arrhythmia surgery. Ann Thorac Surg 2006; 81: 1786–1793.CrossRefGoogle ScholarPubMed
Mavroudis, C, Deal, BJ, Backer, CL, Tsao, S. Arrhythmia surgery in patients with and without congenital heart disease. Ann Thorac Surg 2008; 86: 857–868.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×