{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:15:21Z","timestamp":1787022921579,"version":"build-2736575974"},"reference-count":27,"publisher":"Radcliffe Medical Media Ltd","issue":"4","license":[{"start":{"date-parts":[[2019,12,18]],"date-time":"2019-12-18T00:00:00Z","timestamp":1576627200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/legalcode"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arrhythm Electrophysiol Rev"],"published-print":{"date-parts":[[2020,2,11]]},"abstract":"<p>The moderator band in the right ventricle is being increasingly recognised as a source for arrhythmias in the absence of identifiable structural heart disease. Because it carries part of the conduction system from the right ventricle septum to the free wall, it is a source of Purkinje-mediated ventricular arrhythmias that manifest as premature ventricular contractions (PVC) or repetitive ventricular tachycardia. More importantly, short coupled PVCs triggering polymorphic ventricular tachycardia and VF have been localised to the moderator band and ablation of these Purkinje mediated PVCs can effectively prevent recurrent VF. The exact mechanism of arrhythmogenesis is still debated but stretch, fibrosis and ion channel alterations might be responsible. Arrhythmias originating in this region of the right ventricle may thus be another cause for idiopathic VF that is potentially treatable with catheter-based ablation techniques. Recognition of the typical PVC morphology can point to the moderator band as the source of idiopathic VF and an opportunity for timely intervention. The available data on the anatomy, electrophysiology and management options are reviewed.<\/p>","DOI":"10.15420\/aer.2019.18","type":"journal-article","created":{"date-parts":[[2020,2,25]],"date-time":"2020-02-25T04:31:28Z","timestamp":1582605088000},"page":"294-299","source":"Crossref","is-referenced-by-count":19,"title":["Arrhythmias from the Right Ventricular Moderator Band: Diagnosis and Management"],"prefix":"10.15420","volume":"8","author":[{"given":"Megan","family":"Barber","sequence":"first","affiliation":[{"name":"Nassau University Medical Center, Zucker School of Medicine at Hofstra\/Northwell, NY, US"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Chinitz","sequence":"additional","affiliation":[{"name":"Department of Medicine and Cardiology, Northshore University Hospital, NY, US"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roy","family":"John","sequence":"additional","affiliation":[{"name":"Department of Medicine and Cardiology, Northshore University Hospital, NY, US"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6096","published-online":{"date-parts":[[2020,2,11]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"Visser M, van der Haijden JF, Doevendans PA, et al. Idiopathic ventricular fibrillation: the struggle for definition, diagnosis and follow up. Cir Arrhythm Electrophysiol 2016;9:e003817. https:\/\/doi.org\/10.1161\/CIRCEP.115.003817; PMID: 27103090.","DOI":"10.1161\/CIRCEP.115.003817"},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"John RM, Stevenson WG. Outflow tract premature ventricular contractions and ventricular tachycardia: the typical and the challenging. Card Electrophysiol Clin 2016;8:545-54. https:\/\/doi.org\/10.1016\/j.ccep.2016.04.004; PMID: 27521088.","DOI":"10.1016\/j.ccep.2016.04.004"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Viskin S, Rosso R, Rogowski O, Belhassen B. The \"short-coupled\" variant of right ventricular outflow ventricular tachycardia: a not-so-benign form of benign ventricular tachycardia. J Cardiovasc Electrophysiol 2005;16:912-16. https:\/\/doi.org\/10.1111\/j.1540-8167.2005.50040.x; PMID: 16101636.","DOI":"10.1111\/j.1540-8167.2005.50040.x"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Ha\u00efssaguerre M, Shoda M, Ja\u00efs P, et al. Mapping and ablation of idiopathic ventricular fibrillation. Circulation 2002;106:962-7. https:\/\/doi.org\/10.1161\/01.CIR.0000027564.55739.B1; PMID: 12186801.","DOI":"10.1161\/01.CIR.0000027564.55739.B1"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Ha\u00efssaguerre M, Shah DC, Ja\u00efs P, et al. Role of Purkinje conducting system in triggering of idiopathic ventricular fibrillation. Lancet 2002;359:677-8. https:\/\/doi.org\/10.1016\/S0140-6736(02)07807-8; PMID: 11879868.","DOI":"10.1016\/S0140-6736(02)07807-8"},{"key":"ref5","unstructured":"Yamada T, Kay GN. Anatomical consideration in catheter ablation of idiopathic ventricular arrhythmias. Arrhythm Electrophysiol Rev 2016;5:203-9. https:\/\/doi.org\/10.15420\/aer.2016:31:2; PMID: 28116086."},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Anter E, Buxton AE, Silverstein JR, Josephson ME. Idiopathic ventricular fibrillation originating from the moderator band. J Cardiovasc Electrophysiol 2013;24:97-100. https:\/\/doi.org\/10.1111\/j.1540-8167.2012.02374.x; PMID: 22882745.","DOI":"10.1111\/j.1540-8167.2012.02374.x"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Nogami A, Sugiyasu A, Kutoba S, Kato K. Mapping and ablation of idiopathic ventricular fibrillation from the Purkinje system. Heart Rhythm 2005;2:646-9. https:\/\/doi.org\/10.1016\/j.hrthm.2005.02.006; PMID: 15922276.","DOI":"10.1016\/j.hrthm.2005.02.006"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Nakamura T, Schaeffer B, Tanigawa S, et al. Catheter ablation of polymorphic ventricular tachycardia\/fibrillation in patient with and without structural heart disease. Heart Rhythm 2019;16:1021-27. https:\/\/doi.org\/10.1016\/j.hrthm.2019.01.032; PMID: 30710740.","DOI":"10.1016\/j.hrthm.2019.01.032"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Sadek MM, Benhayon D, Sureddi R, et al. Idiopathic ventricular arrhythmias originating from the moderator band: Electrocardiographic characteristics and treatment by catheter ablation. Heart Rhythm. 2015;12:67-75. https:\/\/doi.org\/10.1016\/j.hrthm.2014.08.029; PMID: 25240695.","DOI":"10.1016\/j.hrthm.2014.08.029"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Ho RT, Frisch DR, Greenspon AJ. Idiopathic ventricular fibrillation ablation facilitated by Pentaray mapping of the moderator band. JACC Clin Electrophysiol 2017;3:313-4. https:\/\/doi.org\/10.1016\/j.jacep.2016.08.006; PMID: 29759527.","DOI":"10.1016\/j.jacep.2016.08.006"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Chinitz JS, Sedaghat D, Harding M, et al. Adjuvant use of a cryoballoon to facilitate ablation of premature ventricular contraction-triggered ventricular fibrillation originating from the moderator band. HeartRhythm Case Rep 2019;5:578-81. https:\/\/doi.org\/10.1016\/j.hrcr.2019.09.001; PMID: 31890580.","DOI":"10.1016\/j.hrcr.2019.09.001"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Loukas M, Klaassen Z, Tubbs RS, et al. Anatomical observations of the moderator band. Clin Anat 2010;23:443-50. https:\/\/doi.org\/10.1002\/ca.20968; PMID: 20235167.","DOI":"10.1002\/ca.20968"},{"key":"ref13","unstructured":"De Almeida MC, Stephenson RS, Anderson RH, et al. Human subpulmonary infundibulum has an endocardial network of specialized conducting cardiomyocytes. Heart Rhythm 2019. https:\/\/doi.org\/10.1016\/j.hrthm.2019.07.033; PMID: 31377422; epub ahead of press."},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Walton, RD, Pashaei A, Martinez ME, et al. 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Role of transient outward potassium current in the genesis of early afterdepolarization in cardiac cells. Cardiovasc Res 2012;95:308-16. https:\/\/doi.org\/10.1093\/cvr\/cvs183; PMID: 22660482.","DOI":"10.1093\/cvr\/cvs183"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"Xiao L, Koopman TT, Ordog B. et al. Unique cardiac Purkinje fiber transient outward current \u03b2-subunit composition: a potential molecular link to idiopathic ventricular fibrillation. Circ Res 2013;112:1310-22. https:\/\/doi.org\/10.1161\/CIRCRESAHA.112.300227; PMID: 23532596.","DOI":"10.1161\/CIRCRESAHA.112.300227"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"Xie Y, Sato D, Garfinker A, et al. So little source, so much sink: requirements for afterdepolarizations to propagate in tissue. Biophys J 2010;99:1408-15. https:\/\/doi.org\/10.1016\/j.bpj.2010.06.042; PMID: 20816052.","DOI":"10.1016\/j.bpj.2010.06.042"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"Kamkin A, Kiseleva I, Isenberg G. Stretch-activated currents in ventricular myocytes: amplitude and arrhythmogenic effects increase with hypertrophy. Cardiovasc Res 2000;48:409-20. https:\/\/doi.org\/10.1016\/S0008-6363(00)00208-X; PMID: 11090836.","DOI":"10.1016\/S0008-6363(00)00208-X"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"Li YQ, Wang YX, Que DD. Et al. Successful ablation of moderator band-originated ventricular tachycardia at its ventricle insertion sites. Chin Med J (Engl) 2018;131:1371-2. https:\/\/doi.org\/10.4103\/0366-6999.232807; PMID: 29786055.","DOI":"10.4103\/0366-6999.232807"},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"Aizawa Y, Chinushi M, Hasegawa K. et al. 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