Abstract
The left ventricular summit (LVS) is a triangular area located at the most superior portion of the left epicardial ventricular region, surrounded by the two branches of the left coronary artery: the left anterior interventricular artery and the left circumflex artery. The triangle is bounded by the apex, septal and mitral margins and base. This review aims to provide a systematic and comprehensive anatomical description and proper terminology in the LVS region that may facilitate exchanging information among anatomists and electrophysiologists, increasing knowledge of this cardiac region. We postulate that the most dominant septal perforator (not the first septal perforator) should characterize the LVS definition. Abundant epicardial adipose tissue overlying the LVS myocardium may affect arrhythmogenic processes and electrophysiological procedures within the LVS region. The LVS is divided into two clinically significant regions: accessible and inaccessible areas. Rich arterial and venous coronary vasculature and a relatively dense network of cardiac autonomic nerve fibers are present within the LVS boundaries. Although the approach to the LVS may be challenging, it can be executed indirectly using the surrounding structures. Delivery of the proper radiofrequency energy to the arrhythmia source, avoiding coronary artery damage at the same time, may be a challenge. Therefore, coronary angiography or cardiac computed tomography imaging is strongly recommended before any procedure within the LVS region. Further research on LVS morphology and physiology should increase the safety and effectiveness of invasive electrophysiological procedures performed within this region of the human heart.
Highlights
Despite the intensive research in the anatomical sciences for the past couple of centuries, some structures within the body remain incompletely described [1,2,3]
In some cases, when the most dominant septal perforator is more proximal to the left coronary artery bifurcation, the anterior interventricular vein may not cross the septal margin of the left ventricular summit (LVS) but is located more distally, outside the LVS triangle
The base of the LVS may be defined as a curved line, with the radius of this arc being the distance from the left coronary artery bifurcation to the first dominant septal perforator originating from the left anterior descending artery [8]
Summary
Despite the intensive research in the anatomical sciences for the past couple of centuries, some structures within the body remain incompletely described [1,2,3]. The proximity of the surrounding major cardiac structures might pose a risk of complications, and ablation within the LVS region may be challenging [7] Important anatomical structures, such as surrounding coronary arteries, epicardial fat and fibrotic components, may complicate the approach [8]. A delineation by an arched line, with the radius of this arc being the distance from the left coronary bifurcation artery to the first prominent left coronary artery septal perforator, represents the most inferior boundary of this arc region (triangle base) Inside this triangular area, the anterior interventricular cardiac vein (that travels through the anterior part of the atrioventricular groove) becomes the great cardiac vein that is further heading to the posterior part of the atrioventricular groove [10,11,12,13,14]. Each part of the LVS has a specific relation to the adjacent anatomical structures, and each will be described below (Figure 1)
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