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Novel cardiac CT method for identifying the atrioventricular conduction axis by anatomic landmarks
Justin T Tretter1, Francisco Bedogni2, Josep Rodés-Cabau3
1Hobart Healthcare Research Institute, London, United Kingdom.
Insights
This study developed a reproducible cardiac computed tomography method to predict the atrioventricular conduction axis location. This approach helps avoid iatrogenic damage and guides heart rhythm therapies by visualizing the variable relationship between the conduction system and aortic root.
Area of Science:
- Cardiovascular Imaging
- Cardiac Electrophysiology
- Anatomical Variation
Background:
- Accurate knowledge of the conduction axis location is crucial for preventing iatrogenic injury during cardiac procedures.
- Variability in the conduction system's course can be predicted using cardiac structures visible on clinical imaging.
Purpose of the Study:
- To standardize and assess the reproducibility of predicting the atrioventricular conduction axis location using cardiac computed tomography (CT).
- To evaluate the relationship between cardiac structures, specifically the aortic root and membranous septum, and the conduction system's course.
Main Methods:
- Cardiac CT was performed on 477 patients with acquired aortic valve disease.
- Three standardized points (A-C) were used to map the conduction axis from the atrioventricular node to the left bundle branch origin.
- Variability in the aortic root and membranous septum was compared with conduction system measures.
Main Results:
- Mean distances from the aortic valve basal ring to points A, B, and C were measured (e.g., 9.5 ± 3.5 mm to point A).
- The membranous septum's midpoint showed significant posterior deviation relative to leaflet commissures.
- Excellent intraobserver and interobserver reliability (Intraclass coefficients ≥0.78) was achieved for all measurements.
Conclusions:
- The study demonstrates an intimate yet highly variable relationship between the conduction axis and the aortic root.
- The developed standardized CT approach is reproducible and requires validation for clinical use in identifying atrioventricular conduction components.
- This method offers a potential noninvasive tool for estimating the conduction axis location.
Background:
Understanding the conduction axis location aids in avoiding iatrogenic damage and guiding targeted heart rhythm therapy.
Objective:
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.
Methods:
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.
Results:
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).
Conclusion:
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.
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