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Review
. 2021 Dec;10(4):262-272.
doi: 10.15420/aer.2021.43.

Inferior Extensions of the Atrioventricular Node

Robert H Anderson  1 , Jill Pjm Hikspoors  2 , Justin T Tretter  3 , Yolanda Macías  4 , Diane E Spicer  5   6 , Wouter H Lamers  2 , Damián Sánchez-Quintana  4 , Eduardo Back Sternick  7
Affiliations
Review

Inferior Extensions of the Atrioventricular Node

Robert H Anderson et al. Arrhythm Electrophysiol Rev. 2021 Dec.

Abstract

The pathways for excitation of the atrioventricular node enter either superiorly, as the so-called 'fast' pathway, or inferiorly as the 'slow' pathway. However, knowledge of the specific anatomical details of these pathways is limited. Most of the experimental studies that established the existence of these pathways were conducted in mammalian hearts, which have subtle differences to human hearts. In this review, the authors summarise their recent experiences investigating human cardiac development, correlating these results with the arrangement of the connections between the atrial myocardium and the compact atrioventricular node as revealed by serial sectioning of adult human hearts. They discuss the contributions made from the atrioventricular canal myocardium, as opposed to the primary ring. Both these rings are incorporated into the atrial vestibules, albeit with the primary ring contributing only to the tricuspid vestibule. The atrial septal cardiomyocytes are relatively late contributors to the nodal inputs. Finally, they relate our findings of human cardiac development to the postnatal arrangement.

Keywords: Conduction tissues; animal species; development; fast pathway; slow pathway.

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Conflict of interest statement

Disclosure: RHA is on the Arrhythmia & Electrophysiology Review editorial board; this did not influence peer review. All other authors have no conflicts of interest to disclose.

Figures

Figure 1:
Figure 1:. Using Serial Histological Sectioning to Define a Conducting Tract
Figure 2:
Figure 2:. Nodes Versus Conducting Tracts
Figure 3:
Figure 3:. Architectural Arrangement of the Atrioventricular Conduction Axis
Figure 4:
Figure 4:. Human Embryos in the Fifth Week of Development
Figure 4:
Figure 4:. Human Embryos in the Fifth Week of Development
Figure 5:
Figure 5:. Site of Penetration of the Atrioventricular Conduction Axis
Figure 6:
Figure 6:. Fibroadipose Tissues Occupying the Inferior Pyramidal Space
Figure 7:
Figure 7:. Relationship Between the Apex of the Inferior Pyramidal Space and the Inferoseptal Recess of the Left Ventricle
Figure 8:
Figure 8:. Approximate Locations Relative to the Triangle of Koch
Figure 9:
Figure 9:. Dominant Rightward Inferior Extension
Figure 10:
Figure 10:. Serial Histological Sectioning Showing Minimal Connections Between the Septum and Compact Node
See this image and copyright information in PMC

References

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