Anatomy of the Atrioventricular Conduction System

Excitation of the Intrinsic Conduction System Through His and Interventricular Septal Pacing

“…The His bundle acts as a conduit between the atrium and the ventricles, transmitting depolarization from the AVN through the fibrous skeleton to the right and left bundle branches and ultimately the Purkinje system 1 . The further characterization of the anatomical and electrophysiological features of the AVN and the bundle of His is an area of current scientific interest, and ongoing controversy 2–4 . Recent clinical interest surrounding the AVN and the His bundle has been related to: (1) their direct stimulation in patients requiring pacing as a potential means to optimize hemodynamic performance, 5–11 and (2) the study of atrioventricular (AV) nodal reentrant tachycardias 12–15 .…”

“…The further characterization of the anatomical and electrophysiological features of the AVN and the bundle of His is an area of current scientific interest, and ongoing controversy. [2][3][4] Recent clinical interest surrounding the AVN and the His bundle has been related to: (1) their direct stimulation in patients requiring pacing as a potential means to optimize hemodynamic performance, [5][6][7][8][9][10][11] and (2) the study of atrioventricular (AV) nodal reentrant tachycardias. [12][13][14][15] The bundle of His and the ventricular conduction system typically remain intact after therapeutic AV node ablation, potentially allowing a normal physiologic ventricular contraction sequence to be restored by appropriately stimulating in the His bundle region.…”