{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:03:01Z","timestamp":1760148181447,"version":"build-2065373602"},"reference-count":38,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,4,6]],"date-time":"2023-04-06T00:00:00Z","timestamp":1680739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>The moderator band (MB) is an intracavitary structure of the right ventricle composed of muscular fibers encompassing specialized Purkinje fibers, separated each other by collagen and adipose tissue. In the last decades, premature ventricular complexes originating within the Purkinje network have been implicated in the genesis of life-threatening arrhythmias. However, right Purkinje network arrhythmias have been much less reported in the literature compared to the left counterpart. The MB has unique anatomical and electrophysiological properties, which may account for its arrhythmogenicity and may be responsible for a significant portion of idiopathic ventricular fibrillation. MB embodies autonomic nervous system cells, with important implications in arrhythmogenesis. Some idiopathic ventricular arrhythmias, defined as the absence of any identifiable structural heart disorder, can begin from this site. Due to these complex structural and functional peculiarities strictly interplayed each other, it is arduous to determine the precise mechanism underlying MB arrhythmias. MB-related arrhythmias should be differentiated from other right Purkinje fibers arrhythmias because of the opportunity for intervention and the unusual site for the ablation poorly described in the literature. In the current paper, we report the characteristics and electrical properties of the MB, their involvement in arrhythmogenesis, clinical and electrophysiological peculiarities of MB-related arrhythmias, and current treatment options.<\/jats:p>","DOI":"10.3390\/jcdd10040159","type":"journal-article","created":{"date-parts":[[2023,4,6]],"date-time":"2023-04-06T01:10:27Z","timestamp":1680743427000},"page":"159","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Moderator Band and Ventricular Tachycardia: Structural or Functional Substrate?"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2106-0884","authenticated-orcid":false,"given":"Federico","family":"Landra","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carmine","family":"Marallo","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2629-4372","authenticated-orcid":false,"given":"Amato","family":"Santoro","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Cardio Thoracic and Vascular Department, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simone","family":"Taddeucci","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Cristina","family":"Tavera","sequence":"additional","affiliation":[{"name":"Cardiovascular Diseases Unit, Cardio Thoracic and Vascular Department, Azienda Ospedaliera Universitaria Senese, University of Siena, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Baiocchi","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Cardio Thoracic and Vascular Department, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6235-984X","authenticated-orcid":false,"given":"Alberto","family":"Palazzuoli","sequence":"additional","affiliation":[{"name":"Cardiovascular Diseases Unit, Cardio Thoracic and Vascular Department, Azienda Ospedaliera Universitaria Senese, University of Siena, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1002\/ca.20968","article-title":"Anatomical observations of the moderator band","volume":"23","author":"Loukas","year":"2010","journal-title":"Clin. Anat."},{"key":"ref_2","first-page":"387","article-title":"On nerves and nerve endings in the conducting sysetm of the moderator band (septomarginal trabecula)","volume":"108","year":"1971","journal-title":"J. Anat."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1111\/j.1540-8167.1993.tb01236.x","article-title":"Idiopathic Ventricular Tachycardia and Fibrillation","volume":"4","author":"Belhassen","year":"1993","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1111\/j.1540-8167.2005.50040.x","article-title":"The \u201cShort-Coupled\u201d Variant of Right Ventricular Outflow Ventricular Tachycardia: A Not-So-Benign Form of Benign Ventricular Tachycardia?","volume":"16","author":"Viskin","year":"2005","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1016\/j.hrthm.2016.01.011","article-title":"Cardiac Purkinje fibers and arrhythmias; The GK Moe Award Lecture 2015","volume":"13","author":"Boyden","year":"2016","journal-title":"Heart Rhythm."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1161\/01.CIR.0000027564.55739.B1","article-title":"Mapping and Ablation of Idiopathic Ventricular Fibrillation","volume":"106","author":"Shoda","year":"2002","journal-title":"Circulation"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1016\/S0140-6736(02)07807-8","article-title":"Role of Purkinje conducting system in triggering of idiopathic ventricular fibrillation","volume":"359","author":"Shah","year":"2002","journal-title":"Lancet"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.hrthm.2014.08.029","article-title":"Idiopathic ventricular arrhythmias originating from the moderator band: Electrocardiographic characteristics and treatment by catheter ablation","volume":"12","author":"Sadek","year":"2015","journal-title":"Heart Rhythm."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1111\/j.1540-8167.2012.02374.x","article-title":"Idiopathic Ventricular Fibrillation Originating from the Moderator Band","volume":"24","author":"Anter","year":"2012","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1016\/j.hrthm.2005.02.006","article-title":"Mapping and ablation of idiopathic ventricular fibrillation from the Purkinje system","volume":"2","author":"Nogami","year":"2005","journal-title":"Heart Rhythm."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e005913","DOI":"10.1161\/CIRCEP.117.005913","article-title":"Compartmentalized Structure of the Moderator Band Provides a Unique Substrate for Macroreentrant Ventricular Tachycardia","volume":"11","author":"Walton","year":"2018","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1016\/j.yjmcc.2011.05.020","article-title":"Anatomical and molecular mapping of the left and right ventricular His\u2013Purkinje conduction networks","volume":"51","author":"Atkinson","year":"2011","journal-title":"J. Mol. Cell. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"38","DOI":"10.5115\/acb.2019.52.1.38","article-title":"Morphological classification of the moderator band and its relationship with the anterior papillary muscle","volume":"52","author":"Lee","year":"2019","journal-title":"Anat. Cell Biol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/j.pharmthera.2013.04.010","article-title":"Structure, function and clinical relevance of the cardiac conduction system, including the atrioventricular ring and outflow tract tissues","volume":"139","author":"Dobrzynski","year":"2013","journal-title":"Pharmacol. Ther."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1083\/jcb.36.3.497","article-title":"Cardiac muscle: A comparative study of Purkinje fibers and ventricular fibers","volume":"36","author":"Sommer","year":"1968","journal-title":"J. Cell Biol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1161\/01.RES.42.5.657","article-title":"Regional choline acetyltransferase activity in the guinea pig heart","volume":"42","author":"Schmid","year":"1978","journal-title":"Circ. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1310","DOI":"10.1161\/CIRCRESAHA.112.300227","article-title":"Unique cardiac Purkinje fiber transient outward current \u03b2-subunit composition: A potential molecular link to idiopathic ventricular fibrillation","volume":"112","author":"Xiao","year":"2013","journal-title":"Circ. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1161\/01.RES.26.3.361","article-title":"Electrophysiological Properties of the Canine Peripheral A-V Conducting System","volume":"26","author":"Myerburg","year":"1970","journal-title":"Circ. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10840-012-9774-2","article-title":"The effects of atrial ganglionated plexi stimulation on ventricular electro-physiology in a normal canine heart","volume":"37","author":"He","year":"2013","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/0735-1097(94)90529-0","article-title":"Clinical relevance of cardiac arrhythmias generated by afterdepolarizations: Role of M cells in the generation of U waves, triggered activity and torsade de pointes","volume":"23","author":"Antzelevitch","year":"1994","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1161\/CIRCRESAHA.111.246512","article-title":"A model of canine purkinje cell electrophysiology and Ca(2+) cycling: Rate dependence, triggered activity, and comparison to ventricular myocytes","volume":"109","author":"Li","year":"2011","journal-title":"Circ. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e004777","DOI":"10.1161\/CIRCEP.116.004777","article-title":"Mechanically Induced Ectopy via Stretch-Activated Cation-Nonselective Channels Is Caused by Local Tissue Deformation and Results in Ventricular Fibrillation if Triggered on the Repolarization Wave Edge (Commotio Cordis)","volume":"10","author":"Quinn","year":"2017","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3997","DOI":"10.1093\/eurheartj\/ehac262","article-title":"2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death","volume":"43","author":"Zeppenfeld","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1007\/s00392-021-01840-z","article-title":"Catheter ablation of short-coupled variant of torsade de pointes","volume":"111","author":"Steinfurt","year":"2021","journal-title":"Clin. Res. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1016\/j.hrthm.2010.01.040","article-title":"Ventricular arrhythmias originating from papillary muscles in the right ventricle","volume":"7","author":"Crawford","year":"2010","journal-title":"Heart Rhythm."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1538","DOI":"10.1016\/j.hrthm.2019.04.002","article-title":"How to use the 12-lead ECG to predict the site of origin of idiopathic ventricular arrhythmias","volume":"16","author":"Enriquez","year":"2019","journal-title":"Heart Rhythm."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/j.hroo.2021.07.009","article-title":"The RV1-V3 transition ratio: A novel electrocardiographic criterion for the differentiation of right versus left outflow tract premature ventricular complexes","volume":"2","author":"Efremidis","year":"2021","journal-title":"Heart Rhythm. O2"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1007\/s00399-021-00746-7","article-title":"Lokalisation ventrikul\u00e4rer Extrasystolen im 12-Kanal-EKG [Localization of ventricular premature contractions by 12-lead ECG]","volume":"32","author":"Fries","year":"2021","journal-title":"Herzschrittmachertherapie Elektrophysiologie"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1111\/jce.12551","article-title":"Ventricular Tachycardia Originating from the Septal Papillary Muscle of the Right Ventricle: Electrocardiographic and Electrophysiological Characteristics","volume":"26","author":"Santoro","year":"2014","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e006049","DOI":"10.1161\/CIRCEP.117.006049","article-title":"Electrophysiological Characteristics of Bundle Branch Reentry Ventricular Tachycardia in Patients Without Structural Heart Disease","volume":"11","author":"Chen","year":"2018","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_31","first-page":"578","article-title":"Adjuvant use of a cryoballoon to facilitate ablation of premature ventricular contraction\u2013triggered ventricular fibrillation originating from the moderator band","volume":"5","author":"Chinitz","year":"2019","journal-title":"Heart Case Rep."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1371","DOI":"10.4103\/0366-6999.232807","article-title":"Successful Ablation of Moderator Band-Originated Ventricular Tachycardia at Its Ventricle Insertion Sites","volume":"131","author":"Li","year":"2018","journal-title":"Chin. Med. J."},{"key":"ref_33","first-page":"3414360","article-title":"Ventricular Tachycardia Originating from Moderator Band: New Perspective on Catheter Ablation","volume":"2017","author":"Li","year":"2017","journal-title":"Case Rep. Cardiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1016\/j.phrs.2019.04.028","article-title":"Quinidine\u2014A legacy within the modern era of antiarrhythmic therapy","volume":"144","author":"Serdoz","year":"2019","journal-title":"Pharmacol. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1007\/s40520-018-1088-5","article-title":"The influence of age on the psychological profile of patients with cardiac implantable electronic devices: Results from the Italian population in a multicenter study conducted by the European Heart Rhythm Association","volume":"31","author":"Fumagalli","year":"2018","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1093\/eurheartj\/ehaa605","article-title":"2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease","volume":"42","author":"Pelliccia","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1007\/s00246-019-02233-w","article-title":"Frequent Ventricular Premature Beats in Children and Adolescents: Natural History and Relationship with Sport Activity in a Long-Term Follow-Up","volume":"41","author":"Porcedda","year":"2019","journal-title":"Pediatr. Cardiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.hrthm.2021.09.013","article-title":"Ventricular arrhythmias in athletes: Role of a comprehensive diagnostic workup","volume":"19","author":"Russo","year":"2021","journal-title":"Heart Rhythm."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/10\/4\/159\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:10:47Z","timestamp":1760123447000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/10\/4\/159"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,6]]},"references-count":38,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,4]]}},"alternative-id":["jcdd10040159"],"URL":"https:\/\/doi.org\/10.3390\/jcdd10040159","relation":{},"ISSN":["2308-3425"],"issn-type":[{"type":"electronic","value":"2308-3425"}],"subject":[],"published":{"date-parts":[[2023,4,6]]}}}