Advertisement

Function follows form: When electrophysiology derives from anatomy

      Tackling an arrhythmia by its mapping and successful ablation demonstrates time and again the art of integrating function and form—or how the analysis of an arrhythmia and its successful treatment is essentially linked to its underlying anatomic substrate. Wilhelm His Jr, after whom the His bundle is named, first described the so-called “spina vestibuli”—the leading edge of the primary atrial septum, forming the buttress binding the atrial septum itself to the insulating tissues of the atrioventricular (AV) junctions.
      • Anderson R.H.
      • Mori S.
      Wilhelm His Junior and his bundle.
      This structure, situated within the center of the heart, is bounded by the aortic and the AV valves, and is an area requiring abundant caution when ablating locally because of its proximity to the AV conduction system. However, the anatomy allows for approaching targets within this area not only from the right atrial (RA) as well as from the left atrial (LA) side but also from the aortic root,
      • Tada H.
      • Naito S.
      • Miyazaki A.
      • Oshima S.
      • Nogami A.
      • Taniguchi K.
      Successful catheter ablation of atrial tachycardia originating near the atrioventricular node from the noncoronary sinus of Valsalva.
      with the aim of avoiding the AV conduction system as well as reaching profoundly situated arrhythmogenic tissue.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Heart Rhythm
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Anderson R.H.
        • Mori S.
        Wilhelm His Junior and his bundle.
        J Electrocardiol. 2016; 49: 637-643
        • Tada H.
        • Naito S.
        • Miyazaki A.
        • Oshima S.
        • Nogami A.
        • Taniguchi K.
        Successful catheter ablation of atrial tachycardia originating near the atrioventricular node from the noncoronary sinus of Valsalva.
        Pacing Clin Electrophysiol. 2004; 27: 1440-1443
        • Yang J.D.
        • Sun Q.
        • Guo X.G.
        • Zhou G.B.
        • Liu X.
        • Luo B.
        • Wei H.Q.
        • Liang J.J.
        • Zhang S.
        • Ma J.
        Focal atrial tachycardias from the parahisian region: strategies for mapping and catheter ablation.
        Heart Rhythm. 2017; 14: 1344-1350
        • Iesaka Y.
        • Takahashi A.
        • Goya M.
        • Soejima Y.
        • Okamoto Y.
        • Fujiwara H.
        • Aonuma K.
        • Nogami A.
        • Hiroe M.
        • Marumo F.
        • Hiraoka M.
        Adenosine-sensitive atrial reentrant tachycardia originating from the atrioventricular nodal transitional area.
        J Cardiovasc Electrophysiol. 1997; 8: 854-864
        • Lai L.P.
        • Lin J.L.
        • Chen T.F.
        • Ko W.C.
        • Lien W.P.
        Clinical, electrophysiological characteristics, and radiofrequency catheter ablation of atrial tachycardia near the apex of Koch’s triangle.
        Pacing Clin Electrophysiol. 1998; 21: 367-374
        • Mlcochova H.
        • Wichterle D.
        • Peichl P.
        • Kautzner J.
        Catheter ablation of focal atrial tachycardia from the aortic cusp: the role of electroanatomic mapping and intracardiac echocardiography.
        Pacing Clin Electrophysiol. 2013; 36: e19-e22
        • Lyan E.
        • Toniolo M.
        • Tsyganov A.
        • Rebellato L.
        • Proclemer A.
        • Manfrin M.
        • Nechepurenko A.
        • Morozov A.
        • Abdrahmanov A.
        • Gromyko G.
        • Lyashenko V.
        • Yakovleva M.
        Comparison of strategies for catheter ablation of focal atrial tachycardia originating near the His bundle region.
        Heart Rhythm. 2017; 14: 998-1005

      Linked Article