Tretter Justin T, Bedogni Francisco, Rodés-Cabau Josep, Regueiro Ander, Testa Luca, Eleid Mackram F, Chen Shmuel, Galhardo Attilio, Ellenbogen Kenneth A, Leon Martin B, Ben-Haim Shlomo
Hobart Healthcare Research Institute, London, United Kingdom.
Policlinico San Donato, Milan, Italy.
Heart Rhythm. 2025 Mar;22(3):776-785. doi: 10.1016/j.hrthm.2024.12.022. Epub 2024 Dec 18.
Understanding the conduction axis location aids in avoiding iatrogenic damage and guiding targeted heart rhythm therapy.
Cardiac structures visible with clinical imaging have been demonstrated to correlate with variability in the conduction system course. We aimed to standardize and assess the reproducibility of predicting the location of the atrioventricular conduction axis by cardiac computed tomography.
We evaluated 477 patients with acquired aortic valve disease by cardiac computed tomography to assess variability in cardiac structures established to relate to the conduction system. We standardized 3 points (points A-C) to estimate the course from the atrioventricular node to the nonbranching bundle and left bundle branch origin and further compared this with measures of variability in the aortic root and membranous septum.
The mean distances between the aortic valve virtual basal ring and points A, B, and C were 9.5 ± 3.5 (0.3-20.1) mm, 5.0 ± 2.6 (-1.7 to 15.9) mm, and 2.9 ± 2.5 (-5.2 to 12.0) mm, respectively. The midpoint of the membranous septum deviated posteriorly a median of -4.4 (interquartile range, -12.4 to +3.0) degrees relative to the commissure between the right coronary and noncoronary leaflets. Intraclass coefficients for both intraobserver and interobserver variability for all measured points were excellent (≥0.78).
These findings further infer the intimate yet highly variable relationship between the conduction axis and aortic root. This reproducible and standardized approach needs validation in populations of patients requiring accurate identification of the atrioventricular components of the conduction axis, which may serve as a noninvasive means for estimating its location.
了解传导轴位置有助于避免医源性损伤并指导靶向性心律治疗。
临床成像可见的心脏结构已被证明与传导系统走行的变异性相关。我们旨在规范并评估通过心脏计算机断层扫描预测房室传导轴位置的可重复性。
我们通过心脏计算机断层扫描评估了477例获得性主动脉瓣疾病患者，以评估已确定与传导系统相关的心脏结构的变异性。我们规范了3个点（A - C点）来估计从房室结到非分支束及左束支起始部的走行，并进一步将其与主动脉根部和膜性间隔的变异性测量值进行比较。
主动脉瓣虚拟基环与A、B、C点之间的平均距离分别为9.5±3.5（0.3 - 20.1）mm、5.0±2.6（-1.7至15.9）mm和2.9±2.5（-5.2至12.0）mm。膜性间隔中点相对于右冠状动脉瓣叶与无冠状动脉瓣叶之间的连合向后偏离的中位数为-4.4（四分位间距，-12.4至+3.0）度。所有测量点的观察者内和观察者间变异性的组内相关系数均极佳（≥0.78）。
这些发现进一步推断了传导轴与主动脉根部之间密切但高度可变的关系。这种可重复且标准化的方法需要在需要准确识别传导轴房室成分的患者群体中进行验证，这可能作为一种估计其位置的非侵入性手段。
