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Conduction System Tutorial
Overview of Cardiac Conduction Control of Ones Heart Rate Cardiac Action Potentials Gap Junctions Atrioventricular Node and Bundle of His Summary and References

Summary

This tutorial reviewed the basic architecture and function of the cardiac conduction system in order to provide the reader with a working knowledge and pertinent vocabulary associated with this topic. While a great deal of literature exists regarding the cardiac conduction system, numerous questions remain related to the detailed histological anatomy and cellular physiology of these specialized conduction tissues and how they become modified in disease states. Future findings associated with the function and anatomy of the cardiac conduction system will likely lead to improvements in therapeutic approaches and medical devices.

References

  1. Anderson RH, Yanni J, Boyett MR, et al. The anatomy of the cardiac conduction system. Clin Anat 2009; 22:99-113.
  2. Ho SY, Kilpatrick L, Kanai T, et al. The architecture of the atrioventricular conduction axis in dog compared to man - its significance to ablation of the atrioventricular nodal approaches. J Cardiovasc Electrophysiol 1995; 6:26-39.
  3. Racker DK, Kadish AH. Proximal atrioventricular bundle, atrioventricular node, and distal atrioventricular bundle are distinct anatomic structures with unique histological characteristics and innervation. Circulation 2000; 101:1049-59.
  4. Furman S. A brief history of cardiac stimulation and electrophysiology - the past fifty years and the next century. NASPE Keynote Address, 1995.
  5. Boyett D, Dobrzynski H. The sinoatrial node is still setting the pace 100 years after its discovery. Circ Res 2007; 100:1543-5.
  6. His Jr W. Die Tatigkeit des embryonalen herzens und deren bedcutung fur die lehre von der herzbewegung beim erwachsenen. Artbeiten aus der Medizinischen Klinik zu Leipzig 1893; 1:14-49.
  7. Tawara S. Das Reizleitungssystem des Saugetierherzens: Eine anatomisch-histologische Studie uber das Atrioventrikularbundel und die Purkinjeschen Faden. Jena, Germany: Gustav Fischer 1906; 9-70, 114-56.
  8. Conti AA, Giaccardi M, Yen Ho S, et al. Koch and the "ultimum moriens" theory - the last part to die of the heart. J Interv CardElectrophysiol 2006; 15:69-70.
  9. Koch WK. Der funktionelle bau des menschlichen herzen. Berlin and Vienna; Urban und Schwarzenberg 1922.
  10. Yamamoto M, Dobrzynski H, Tellez J, et al. Extended atrial conduction system characterised by the expression of the HCN4 channel and connexin45. Cardiovasc Res 2006; 72:271-81
  11. Betts TR, Roberts PR, Ho SY, et al. High density mapping of shifts in the site of earliest depolarization during sinus rhythm and sinus tachycardia. PACE 2003; 26:874-82.
  12. Boineau JB, Schuessler RB, Hackel DB, et al. Widespread distribution and rate differentiation of the atrial pacemaker complex. Am J Physiol 1980; 239:H406-15.
  13. Boineau JB, Schuessler RB, Mooney CR. Multicentric origin of the atrial depolarization wave: the pacemaker complex. Relation to the dynamics of atrial conduction, P-wave changes and heart rate control. Circulation 1978; 58:1036-48.
  14. Lee RJ, Kalman JM, Fitzpatrick AP, et al. Radiofrequency catheter modification of the sinus node for 'inappropriate' sinus tachycardia. Circulation 1995; 92:2919-28.
  15. Tranum-Jensen J. The fine structure of the atrial and atrio-ventricular (AV) junctional specialized tissues of the rabbit heart. In: Wellens HJJ, Lie KI, Janse MJ, editors. The conduction system of the heart: structure, function, and clinical implications. Philadelphia, PA: Lea & Febiger, 1976:55-81.
  16. Waller BF, Gering LE, Branyas NA, et al. Anatomy, histology, and pathology of the cardiac conduction system: Part I. Clinical cardiology 1993; 16:249-52.
  17. Boyett MR, Honjo H, Kodama I, et al. The sinoatrial node: cell size does matter. Circ Res 2007; 101:e81-2.
  18. Garson AJ, Bricker JT, Fisher DJ, Neish SR, editors. The Science and Practice of Pediatric Cardiology. Volume I. Baltimore, MD: Williams & Williams, 1998:141-3.
  19. Li JL, Greener ID, Inada S, et al. Computer three-dimensional reconstruction of the atrioventricular node. Circ Res 2008; 102:975-85.
  20. Yin L, Laske TG, Rakow N, et al. Intracardiac echocardiography-guided his bundle pacing and atrioventricular nodal ablation. Pacing Clin Electrophysiol 2008; 31:536-42.
  21. Becker AE, Anderson RH. The morphology of the human atrioventricular junctional area. In: Wellens HJJ, Lie KI, Janse MJ, editors. The conduction system of the heart: structure, function, and clinical implications. Philadelphia, PA: Lea & Febiger, 1976:263-86.
  22. Aschoff L. Referat uber die herzstorungen in ihren bezeihungen zu den spezifischen muskelsystem des herzens. Verh Dtsch Ges Pathol 1910; 14:3-35.
  23. Monckeberg JG. Beitrage zur normalen und pathologischen anatomie des herzens. Verh Dtsch Ges Pathol 1910; 14:64-71.
  24. Hucker WJ, McCain ML, Laughner JI, et al. Connexin 43 expression delineates two discrete pathways in the human atrioventricular junction. Anat Rec 2008; 291:204-15.
  25. Davis LM, Rodefeld ME, Green K, et al. Gap junction protein phenotypes of the human heart and conduction system. J Cardiovasc Electrophysiol 1995; 6:813-22
  26. Laske TG, Skadsberg ND, Hill AJ, et al. Excitation of the intrinsic conduction system through His and intraventricular septal pacing. Pacing Clin Electrophysiol 2006; 29:397-405.
  27. Hucker WJ, Fedorov VV, Foyil KV, et al. Optical mapping of the human atrioventricular junction. Circulation 2008; 117:1474-7.

Additional Reference Texts

  • Mohrman DE, Heller LJ. Cardiovascular Physiology, fifth edition. New York: Langer Medical Books/McGraw-Hill, 2003.
  • Wellens HJJ, Lie KI, Janse MJ. The Conduction System of the Heart: Structure, Function, and Clinical Implications. Philadelphia: Lea & Febiger, 1976.
  • Sigg DS, Iaizzo PA, Xiao Y-F, He B (Editors) Cardiac Electrophysiology Methods and Models, Springer, Inc. 2010.
  • Alexander RW, Schlant RC, Fuster V. Hurst's: The Heart: Arteries and Veins, ninth edition. New York: McGraw-Hill, 1998.
  • Katz AM. Physiology of the Heart, third edition. Philadelphia: Lippincott, Williams, and Wilkins, 2001.
  • Tortora GJ, Grabowski SR. Principles of Anatomy and Physiology, ninth edition. New York: John Wiley & Sons, Inc., 2000.