The bundle of His (atrioventricular bundle) is a short cord of conducting fibres that continues from the AV node into the ventricles. It is the only normal pathway through the fibrous skeleton that electrically insulates the atria from the ventricles. At the top of the muscular septum it divides into the right and left bundle branches.
| Location | Runs from the AV node through the central fibrous body, then along the lower border of the membranous part of the interventricular septum. |
|---|---|
| Parts |
|
| Blood Supply | Atrioventricular nodal artery; Septal perforators of the left anterior descending artery |
Carries the electrical impulse rapidly from the AV node to the bundle branches so that the ventricles are activated in a coordinated way. It can also generate an escape rhythm if higher pacemakers fail.
Because it passes close to the membranous septum and the aortic and tricuspid valves, the bundle can be damaged during valve surgery, catheter valve replacement or ventricular septal defect repair, causing heart block. His bundle pacing is a technique that places a pacing lead directly on the bundle to give more natural ventricular activation.
Conduction failure at or below the bundle of His. It tends to be less stable than block in the AV node and usually needs a pacemaker.
Damage to the bundle during cardiac surgery or transcatheter aortic valve implantation. It may be temporary or permanent.
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