Abstract
Background: The left bundle branch (LBB) in human heart is very thin and certainly individually different, so the corresponding anatomical data is relatively rare. The gradual spread of His-Purkinje system pacing and aortic valve replacement is in great need of support from the morphological data of LBB. Our pre-investigation suggested that the morph of LBB may be ethnically different. Therefore, we herein focus on exploring and summarizing the morphological characteristics of LBB in the Chinese adult hearts. Methods: The LBB of 35 Chinese adult hearts were microanatomized by the system of stereomicroscope & camera, and then the anatomical elements of the LBB were examined, measured and statistically analyzed under this system. Results: The widths of proximal portion of the LBB were approximately 1 cm (\({\overline{\text{x}}}\) ± S, 0.92 ± 0.22 cm), and the shapes of it were flat and broad. This characteristic of shape bears traces of natural selection. On the other hand, in the view from the left ventricular septum, the minimum distances between the anterior boundary of LBB and the right coronary aortic valve ring (RCAR) were only about 1 mm (\({\overline{\text{x}}}\) ± S, 1.02 ± 0.58 mm), and the posterior boundary almost coincided with the posterior angle of the membranous septum (Near the central fibrous body). By comparison, some anatomical elements of LBB in the Chinese adult heart should be different from those in other ethnic heart. Conclusion: The RCAR and the posterior angle of the membranous septum can be used to estimate the range of the proximal portion of LBB in Chinese hearts.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Qian, Z., et al.: Lead performance and clinical outcomes of patients with permanent His-Purkinje system pacing: a single-centre experience. Europace 22, i45-53 (2020). https://doi.org/10.1093/europace/euaa295
Jastrzebski, M.: ECG and pacing criteria for differentiating conduction system pacing from myocardial pacing. Arrhythm Electrophysiol Rev. 10, 172–180 (2021). https://doi.org/10.15420/aer.2021.26
Vijayaraman, P., et al.: His-Purkinje conduction system pacing following transcatheter aortic valve replacement: feasibility and safety. JACC Clin. Electrophysiol. 6, 649–657 (2020). https://doi.org/10.1016/j.jacep.2020.02.010
Muthumala, A., Vijayaraman, P.: Clinical outcomes of His-Purkinje conduction system pacing. Pacing Clin. Electrophysiol. 44(1), 5–14 (2021). https://doi.org/10.1111/pace.14050. Epub 2020 Sep 7. PMID: 32852056
Vijayaraman, P., Dandamudi, G., Ellenbogen, K.A.: Electrophysiological observations of acute His bundle injury during permanent His bundle pacing. J. Electrocardiol. 49, 664–669 (2016). https://doi.org/10.1016/j.jelectrocard.2016.07.006
Yang, Y.H., Wang, K.X., Ma, P.P., et al.: His-purkinje system pacing upgrade improve the heart performances in patients suffering from pacing-induced cardiomyopathy with or without permanent atrial fibrillation. Int. J. Cardiol. 335, 47–51 (2021). https://doi.org/10.1016/j.ijcard.2021.04.012
Uhley, H.N., Rivkin, L.M.: Visualization of the left branch of the human atrioventricular bundle. Circulation 20, 419–421 (1959). https://doi.org/10.1161/01.cir.20.3.419
Spach, M.S., Huang, S., Armstrong, S.I., Canent, R.J.: Demonstration of peripheral conduction system in human hearts. Circulation 28, 333–338 (1963). https://doi.org/10.1161/01.cir.28.3.333
Nagarajan, V.D., Ho, S.Y., Ernst, S.: Anatomical considerations for his bundle pacing. Circ. Arrhythm. Electrophysiol. 12, e6897 (2019). https://doi.org/10.1161/CIRCEP.118.006897
James, T.N.: Structure and function of the sinus node, AV node and His bundle of the human heart: part I-structure. Prog. Cardiovasc. Dis. 45, 235–267 (2002). https://doi.org/10.1053/pcad.2002.130388
Kawashima, T., Sasaki, H.: A macroscopic anatomical investigation of atrioventricular bundle locational variation relative to the membranous part of the ventricular septum in elderly human hearts. Surg. Radiol. Anat. 27, 206–213 (2005). https://doi.org/10.1007/s00276-004-0302-7
Elizari, M.V.: The normal variants in the left bundle branch system. J. Electrocardiol. 50, 389–399 (2017). https://doi.org/10.1016/j.jelectrocard.2017.03.004
Gómez-Torres, F., Ballesteros-Acuña, L., Ruíz-Sauri, A.: Morphological variations of the conduction system in the atrioventricular zone and its clinical relationship in different species. Anat. Sci. Int. 96(2), 212–220 (2020). https://doi.org/10.1007/s12565-020-00575-7
Atkinson, A.J., et al.: Functional, anatomical, and molecular investigation of the cardiac conduction system and arrhythmogenic atrioventricular ring tissue in the rat heart. J. Am. Heart Assoc. 2(6), e000246 (2013). https://doi.org/10.1161/JAHA.113.000246. PMID: 24356527; PMCID: PMC3886739
Miquerol, L., et al.: Architectural and functional asymmetry of the His-Purkinje system of the murine heart. Cardiovasc. Res. 63(1), 77–86 (2004). https://doi.org/10.1016/j.cardiores.2004.03.007. PMID: 15194464
Ryu, S., Yamamoto, S., Andersen, C.R., Nakazawa, K., Miyake, F., James, T.N.: Intramural Purkinje cell network of sheep ventricles as the terminal pathway of conduction system. Anat. Rec. (Hoboken) 292(1), 12–22 (2009). https://doi.org/10.1002/ar.20827. PMID: 19051253
Scheinman, M.M.: Role of the His-Purkinje system in the genesis of cardiac arrhythmia. Heart Rhythm 6(7), 1050–1058 (2009). https://doi.org/10.1016/j.hrthm.2009.03.011. Epub 2009 Mar 11. PMID: 19481504
Padala, S.K., Cabrera, J.A., Ellenbogen, K.A.: Anatomy of the cardiac conduction system. Pacing Clin. Electrophysiol. 44(1), 15–25 (2021). https://doi.org/10.1111/pace.14107. Epub 2020 Nov 12. PMID: 33118629
Lou, Y., et al.: Macro-micro-anatomy of the atrioventricular node, atrioventricular ring and retroaortic node in the human heart. Acta Anatomica Sinica 48(3), 316–321 (2017). https://doi.org/10.16098/j.issn.0529-1356.2017.03.011. (in Chinese)
Lou, Y., et al.: New examination of the atrioventricular conduction axis in the adult human heart under the stereomicroscope. Chin. J. Anat. 39(3), 285–289 (2016). https://doi.org/10.3969/j.issn.1001-1633.2016.03.007. (in Chinese)
Ke, J., et al.: Preparation and display of anatomical specimen of human atrioventricular conduction system. Chin. J. Anat. 43(2), 149–151 (2020). (in Chinese)
Yan, G.X.: Inverse decremental conduction heralds complete atrioventricular block following transcatheter aortic valve replacement. HeartRhythm Case Rep. 7(12), 820–824 (2021). https://doi.org/10.1016/j.hrcr.2021.09.003. PMID: 34987967; PMCID: PMC8695289
Stephenson, R.S., et al.: High resolution 3-dimensional imaging of the human cardiac conduction system from microanatomy to mathematical modeling. Sci. Rep. 7(1), 7188 (2017). https://doi.org/10.1038/s41598-017-07694-8. PMID: 28775383; PMCID: PMC5543124
Acknowledgements
This work was supported by Medical Health Science and Technology Project Fund of Zhejiang Province (No. 2020KY108).
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this paper
Cite this paper
Lou, Y. et al. (2023). Microanatomy of Left Bundle Branch in Chinese Adult Hearts: Aiming to the Research on Morphological Information. In: Wen, S., Yang, C. (eds) Biomedical and Computational Biology. BECB 2022. Lecture Notes in Computer Science(), vol 13637. Springer, Cham. https://doi.org/10.1007/978-3-031-25191-7_11
Download citation
DOI: https://doi.org/10.1007/978-3-031-25191-7_11
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-25190-0
Online ISBN: 978-3-031-25191-7
eBook Packages: Computer ScienceComputer Science (R0)