{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T07:18:36Z","timestamp":1788247116471,"version":"build-2803163510"},"reference-count":48,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T00:00:00Z","timestamp":1757635200000},"content-version":"unspecified","delay-in-days":73,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["23K11939"],"award-info":[{"award-number":["23K11939"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2025,8,4]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Transient or permanent iatrogenic conduction disturbances from injury to arteries supplying the cardiac conduction system (CCS) have increased. A more comprehensive understanding of CCS arterial anatomy is essential for advancing electrophysiological studies. Compared with the sinus node (SN) artery, atrioventricular node (AVN) artery is more variable and difficult to identify because of the thicker surrounding myocardium. Arterial sources other than the main AVN artery branching near the cardiac crux\u2014such as the Bonapace\u2019s septal branch or Kugel\u2019s collateral artery\u2014have often been overlooked or regarded as atypical and remain poorly characterised.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An alternative origin and course of the AVN artery were examined in 116 hearts via microdissection and in 14 additional hearts using serial histological sections of physiologically aged hearts without coronary artery occlusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>An additional descending AVN artery was observed in 22.4% of cases and an interatrial septal branch extending to Koch\u2019s triangle was found in 11.2% based on the macroscopic analysis\u2014findings aligning well with the histologically verified incidence of 35.7%. These results suggest that approximately one-third of individuals exhibit an additional descending AVN artery with features resembling the normal Bonapace\u2019s septal branch. Notably, this additional artery originates from a common trunk with the SN artery and Bachmann\u2019s bundle branches, forming an arterial complex supplying the proximal conduction components.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Using a large sample size, our findings highlight the anatomical and clinical importance of the arterial complex supplying the proximal conduction components, including the additional descending AVN artery. This arterial complex may include the Bonapace\u2019s septal branch and serve as a Kugel\u2019s collateral route in coronary occlusion. This characterisation provides basic essential anatomical data to support future research on iatrogenic conduction disturbances.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2025-003520","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T04:40:23Z","timestamp":1757652023000},"page":"e003520","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Anatomical characterisation of an additional atrioventricular node artery contributing to the arterial complex of proximal conduction components: Bonapace\u2019s septal branch or Kugel\u2019s collateral artery"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9543-5167","authenticated-orcid":false,"given":"Tomokazu","family":"Kawashima","sequence":"first","affiliation":[{"name":"Department of Anatomy, Toho University, Ota-ku, Tokyo, 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