Anatomy and Physiology of the Cardiac Conduction System

The intrinsic conduction system of the heart is comprised of several specialized subpopulations of cells that either spontaneously generate electrical activity (pacemaker cells) or preferentially conduct this excitation throughout the four chambers of the heart in a coordinated fashion. This chapter will discuss some of the details of this anatomy as well as physiological properties of the system. The cardiac action potential underlies signaling within the heart, and various myocyte populations elicit signature waveforms. The recording or active sensing of these action potentials is important in both research and clinical arenas. This chapter aims to provide a basic understanding of the cardiac conduction system, so the reader has a foundation for future research and reading on this topic. The information in this chapter is not comprehensive and should not be used to make decisions related to patient care.

[1]  田淵 淳,et al.  Das Reizleitungssystem des Säugetierherzens : eine anatomisch-histologische Studie über das Atrioventrikularbündel und die Purkinjeschen Fäden , 1906 .

[2]  D. Casavant,et al.  Permanent, direct His-bundle pacing: a novel approach to cardiac pacing in patients with normal His-Purkinje activation. , 2000, Circulation.

[3]  M R Boyett,et al.  The sinoatrial node is still setting the pace 100 years after its discovery. , 2007, Circulation research.

[4]  A H Kadish,et al.  Proximal atrioventricular bundle, atrioventricular node, and distal atrioventricular bundle are distinct anatomic structures with unique histological characteristics and innervation. , 2000, Circulation.

[5]  S. Bharati,et al.  Anatomy of the atrioventricular conduction system. , 2001, Circulation.

[6]  Nader Moazami,et al.  Images in cardiovascular medicine. Optical mapping of the human atrioventricular junction. , 2008, Circulation.

[7]  Paul A Iaizzo,et al.  Connexin 43 Expression Delineates Two Discrete Pathways in the Human Atrioventricular Junction , 2008, Anatomical record.

[8]  Walter. Koch,et al.  Der funktionelle Bau des menschlichen Herzens , 1922 .

[9]  H Honjo,et al.  The sinoatrial node: cell size does matter. , 2007, Circulation research.

[10]  J. Haas,et al.  Altered Cardiac Histology Following Apical Right Ventricular Pacing in Patients with Congenital Atrioventricular Block , 1999, Pacing and clinical electrophysiology : PACE.

[11]  M. Scheinman,et al.  Long-term His-bundle pacing and cardiac function. , 2000, Circulation.

[12]  Yi Zheng,et al.  Intracardiac Echocardiography‐Guided His Bundle Pacing and Atrioventricular Nodal Ablation , 2008, Pacing and clinical electrophysiology : PACE.

[13]  Robert C. Schlant,et al.  Hurst's the Heart, Arteries and Veins , 1998 .

[14]  John G Webster,et al.  Design of Cardiac Pacemakers , 1995 .

[15]  P. Tchou,et al.  His Electrogram Alternans Reveal Dual-Wavefront Inputs Into and Longitudinal Dissociation Within the Bundle of His , 2001, Circulation.

[16]  A. Garson,et al.  The Science and Practice of Pediatric Cardiology , 1998 .

[17]  J. Tranum-Jensen,et al.  The Fine Structure of the Atrial and Atrioventricular (AV) Junctional Specialized Tissues of the Rabbit Heart , 1978 .

[18]  T. Mazgalev,et al.  Anatomic-Electrophysiological Correlations Concerning the Pathways for Atrioventricular Conduction , 2001, Circulation.

[19]  Mitsuru Yamamoto,et al.  Extended atrial conduction system characterised by the expression of the HCN4 channel and connexin45. , 2006, Cardiovascular research.

[20]  A. Katz.  Physiology of the heart , 1977 .

[21]  Luigi Padeletti,et al.  Koch and the “ultimum moriens” theory—the last part to die of the heart , 2006, Journal of interventional cardiac electrophysiology.

[22]  Halina Dobrzynski,et al.  The anatomy of the cardiac conduction system , 2009, Clinical anatomy.

[23]  R. Lewis,et al.  Chronic epicardial His bundle recordings in awake nonsedated dogs: a new method. , 1983, American heart journal.

[24]  R B Schuessler,et al.  Widespread distribution and rate differentiation of the atrial pacemaker complex. , 1980, The American journal of physiology.

[25]  R B Schuessler,et al.  Multicentric Origin of the Atrial Depolarization Wave: The Pacemaker Complex , 1978, Circulation.

[26]  Y Rudy,et al.  Mechanistic Insights Into Very Slow Conduction in Branching Cardiac Tissue: A Model Study , 2001, Circulation research.

[27]  J E Saffitz,et al.  Gap Junction Protein Phenotypes of the Human Heart and Conduction System , 1995, Journal of cardiovascular electrophysiology.

[28]  K B Stokes,et al.  Septal His‐Purkinje Ventricular Pacing in Canines: A New Endocardial Electrode Approach , 1992, Pacing and clinical electrophysiology : PACE.

[29]  Paul A Iaizzo,et al.  Excitation of the Intrinsic Conduction System Through His and Interventricular Septal Pacing , 2006, Pacing and clinical electrophysiology : PACE.

[30]  B F Waller,et al.  Anatomy, histology, and pathology of the cardiac conduction system—part VI , 1993, Clinical cardiology.

[31]  B. Waller,et al.  Anatomy, histology, and pathology of the cardiac conduction system. III , 1993 .

[32]  S. Ho,et al.  The Architecture of the Atrioventricular Conduction Axis in Dog Compared to Man: , 1995, Journal of cardiovascular electrophysiology.

[33]  Michiel J. Janse,et al.  The Conduction System of the Heart: Structure, Function and Clinical Implications , 1978 .

[34]  J. Olgin,et al.  Radiofrequency catheter modification of the sinus node for "inappropriate" sinus tachycardia. , 1995, Circulation.

[35]  Henggui Zhang,et al.  Computer Three-Dimensional Reconstruction of the Atrioventricular Node , 2008, Circulation research.

[36]  Robert H. Anderson,et al.  Morphology of the Human Atrioventricular Junctional Area , 1978 .

[37]  Alan V. Sahakian,et al.  A simultaneous multichannel monophasic action potential electrode array for in vivo epicardial repolarization mapping , 2001, IEEE Transactions on Biomedical Engineering.

[38]  M Shrivastav.  Methods of ambulatory detection and treatment of cardiac arrhythmias using implantable cardioverter-defibrillators. , 1999, Biomedical instrumentation & technology.

[39]  Siew Yen Ho,et al.  High Density Endocardial Mapping of Shifts 
 in the Site of Earliest Depolarization During Sinus Rhythm and Sinus Tachycardia , 2003, Pacing and clinical electrophysiology : PACE.

[40]  R Lazzara,et al.  Selective versus non-selective His bundle pacing. , 1976, Cardiovascular research.