title: Synchronous ventricular pacing with direct capture of the atrioventricular conduction system: Functional anatomy, terminology, and challenges.
abstract: Right ventricular apical pacing is associated with an increased incidence of heart failure, atrial fibrillation, and overall mortality. As a result, pacing the ventricles in a manner that closely mimics normal AV conduction with an intact His-Purkinje system has been explored. Recently, the sustainable benefits of selective His-bundle stimulation have been demonstrated and proposed as the preferred method of ventricular stimulation for appropriate patients. Ideally, conduction system pacing should be selective without myocardial capture, overcome distal bundle branch block when present, and not compromise tricuspid valve function. Contemporary literature on conduction system pacing is confusing largely because of inconsistent terminology and, at times, anatomically inaccurate terms used interchangeably for nonsynonymous anatomic sites. In this review, we discuss the functional anatomy of AV conduction access with specific emphasis on terminology, relationship to the membranous septum, tricuspid valve tissue, and proximity to atrial or ventricular myocardium. The potential benefits of each specific site as well as associated unique difficulties with those sites are described.
authors: Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors: Siva K
authors: SK
authors: Mulpuru
authors: Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors: Yong-Mei
authors: YM
authors: Cha
authors: Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: asirvatham.samuel@mayo.edu.
authors: Samuel J
authors: SJ
authors: Asirvatham
mesh_terms: D001283:Atrioventricular Node / Q000503:physiopathology*; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000379:methods; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D009626:Terminology as Topic
keywords: Atrioventricular node; Cardiac pacing; Conduction system; His bundle; Ventricular synchrony