RT-177
|
To understand atrial
arrhythmias, we need to make nomenclature match anatomy!
|
|
|
Francisco G. Cosío, Robert H.
Anderson, Karl Kuck, on behalf of the Cardiac Nomenclature Study Group of the Working
Group of Arrhythmias of the European Society of Cardiology.
Cardiology Service, University Hospital of Getafe, Madrid, Spain
|
|
Abstract
|
|
The current approach to describing accessory pathways
and atrioventricular junctional tissues is derived from a surgical view which distorts the
true anterior-posterior and right-left lateral coordinates of the heart as it lies in the
chest. The position of body has been described for centuries by anatomists with the
subject in the upright position and facing forward. Anterior is then to the front, and
posterior to the back. Up is superior, and down is inferior, with the right and left sides
corresponding to the positions of the limbs. Why should we change this time-honoured
concept when we come to describe the heart? When considered in this light, then the
so-called "anterior" coordinate of the atrioventricular junctions is, in
reality, superior. In similar fashion, the direction presently called posterior is
inferior. The distortion produced by this mistake, which has been adopted without demur by
a generation of electrophysiologists, makes it difficult to correlate logically the
electrocardiographic manifestations of accessory pathways with their location. This
mattered relatively little when therapy for arrhythmias was surgical, but the convention
now creates confusion when interventionists move catheters to ablate abnormal pathways,
since the fluoroscopic screen shows the thorax in the upright position. There is now an
even more important consequence of this distorted nomenclature, since it is impossible
within the distorted framework properly to describe the tridimensional circuits believed
to be responsible for atrial flutter and fibrillation. If we are to advance our
understanding of atrial and ventricular arrhythmias, we need a uniform nomenclature which
is based on the universally accepted anatomic framework. We present here the bases for
such a nomenclature.
|
Key Words
|
|
Cardiac arrhythmias - classification
atrial-ventricular arrhythmias, anatomical nomenclature, anatomic inaccuracy, uniform
heart structures terminology, R
|
