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Case Reports
. 2023 Dec 8;29(2):102153.
doi: 10.1016/j.jaccas.2023.102153. eCollection 2024 Jan 17.

Myoarchitecture of the Sinoatrial Node and its Relevance for Catheter Ablation: Anatomy and Histology

Alejandro Jiménez Restrepo  1   2 , Mansour Razminia  3 , Damián Sánchez-Quintana  4 , José-Ángel Cabrera  5
Affiliations
Case Reports

Myoarchitecture of the Sinoatrial Node and its Relevance for Catheter Ablation: Anatomy and Histology

Alejandro Jiménez Restrepo et al. JACC Case Rep. .
No abstract available

Keywords: Bachmann bundle; anatomy; attitudinal orientation; autonomic innervation; blood supply; crescent-shaped; epicardial; nodal cells; paranodal region; superior vena cava; terminal crest; topographic variations; transitional zone.

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Conflict of interest statement

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Gross Anatomy and Histology of RA Structures and Anatomical Relationships (A) Lateral view of a human heart specimen showing the course of the right phrenic nerve (arrows) relative to the right atrium (RA). The location of the sinoatrial node (SAN) is outlined (blue dotted line). The double-headed arrow represents the sectioning plane used for making the histologic cross sections through the sinoatrial node and the terminal crest (TC) shown in B. (Masson trichrome stain). (C) Histologic cross- section (Masson trichrome stain) showing the Bachmann bundle bridge across the anterior interatrial groove and its rightward extension toward the sinoatrial node. IVC = inferior vena cava; LA = left atrium; LAA = left atrial appendage; PT = pulmonary trunk; RAA = right atrial appendage; RIPV = right inferior pulmonary vein; RSPV = right superior pulmonary vein; RV = right ventricle; SCV = superior vena cava.
Figure 2
Figure 2
Histology of the SAN Body (Masson Trichrome Stain) (A and B) Histologic sections of the sinoatrial node (SAN) and its nodal artery within a dense matrix of connective tissue (green) and nodal extensions to the superior vena cava (SVC), epicardium, and terminal crest (TC). Note the irregular myoarchitectural contours of the Paranodal zone. (A) Normal density of connective tissue (green); (B) replacement of normal sinoatrial node myocytes with connective tissue (darker green).
Figure 3
Figure 3
Gross Anatomical Specimens Showing Arterial Blood Supply Variations of the SAN (A) Sinoatrial node (SAN) artery (arrow) originating from the right coronary artery (RCA) and located between the right atrial appendage (RAA), superior vena cava (SVC), and aorta. (B) Sinoatrial node artery originating from the circumflex artery and lying on the Bachmann bundle, in a precaval location (arrow) toward the sinoatrial node. (C) Sinoatrial node artery originating from the circumflex artery and located over the Bachmann bundle, in a retrocaval location (arrow) toward the sinoatrial node. (D) Sinoatrial node artery arising from the proximal segment of RCA, coursing to the SVC, and dividing with a circumferential disposition (arrow) around the superior vena cava-right atrial junction. Abbreviations as in Figure 1.
Figure 4
Figure 4
Schematic Representation of Cardiac Autonomic Subplexuses in the Human Heart Arrows represent the neuronal activity output direction. The dorsal right atrial (DRA) subplexus is of particular relevance for sinoatrial node function.
See this image and copyright information in PMC

References

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