The connecting pathways between the sinus node and A-V node and between the right and the left atrium in the human heart

James, Thomas N.

doi:10.1016/0002-8703(63)90382-x

Cited by 401 publications

(120 citation statements)

References 10 publications

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“…Although the same plane of section was used, major discrepancies are still apparent in schematics of the AV junction region 14 -16,18,19,22 and in different studies by the same workers. 16,19,23,24 The real AV junction region tissues were revealed by (1) preservation of the hearts with a protocol that maintains the ultrastructural integrity of paraffinembedded tissues (Racker,12 Figures 1-8 to 1-11), (2) natural flattening of the hearts so that structures could be viewed in orthogonal planes at right angles to each other in 360 degrees, and (3) systematic study of the histological details of the entire AV junction region in 3 orthogonal planes in photomicrographs. A comparison of our data with that generated with conventional protocols reveals that the latter resulted in osmotic damage with a loss of cytoplasmic (eg, Hudson, 3 Figures 2-12C and 2-13C; James, 14 Figures 3B and 3D; and Becker and Anderson, 16 Figure 10) and interstitial (eg, James, 14 Figure 3; McGuire et al, 25 Figures 12 and 13; and Medkour et al, 24 Figure 2) details.…”

Section: Points Of Controversymentioning

confidence: 99%

“…Histological details of myocytes, myofibers, and tissues are also not apparent in orthogonal transverse sections (Table), which are similar to the classic conventional transverse or frontal plane sections. 3,[13][14][15][16][17][18][19]22,23,25 What Is the Atrial or Posterior Input to the AVN? A comparison of histological data for the atrial or posterior input identified by other workers with histological data presented here identifies these structures as ordinary myocardium of the medial atrial wall and, by and large, as various parts of its annular myocardium: terminals of internodal tracts (James,14 Figures 2B, 6, 7, and 9; James, 23 Figures 6C and 6D), the rightward component of the compact AVN (Becker and Anderson, 16 Figure 8A; Inoue and Becker, 19 Figures 2B, 3, and 5 to 7), the overlay and transitional myofibers (James, 14 Figures 2A and 3B; Becker and Anderson, 16 Figure 2A), with the posterior nodal extension and compact AVN (Medkour et al, 24 Figure 2) and the AV nodal ring input being analogous to part or all of the circumferential lamina encircling the tricuspid valve (McGuire et al, 25 Figures 11 and 12) and all of the ordinary atrial myocardium of the AV junction region (Sanchez-Quintana et al, 18 Figure 2).…”

Section: Points Of Controversymentioning

confidence: 99%

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Proximal Atrioventricular Bundle, Atrioventricular Node, and Distal Atrioventricular Bundle Are Distinct Anatomic Structures With Unique Histological Characteristics and Innervation

Racker

Kadish

2000

Circulation

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Background-Direct 3D analysis (ie, stereotaxic analysis of 3 planes) has shown that the atrioventricular (AV) node (AVN) is continuous with only specialized myocardium of the proximal AV bundle (PAVB) and distal AV bundle (DAVB) or His bundle. The purpose of the present study was to determine whether the PAVB, AVN, and DAVB possess histological features distinct from each other and from the ordinary myocardium. Methods and Results-A protocol that preserves the cytoplasmic and interstitial integrity of the tissue and permits serial sections of the AV junction region to be made in 3 orthogonal planes showed that the PAVB, AVN, and DAVB are characterized by myocardium aggregated into fascicles containing Ϸ8 myofibers. Myofibers within the fascicles are coiled or spiraled about each other; and spiraling is most compact in the PAVB. Collagen encases individual fascicles and segregates primary fascicles into secondary fascicles. Fascicles, and not myofibers, are in parallel array in the PAVB, interwoven in the AVN, and parallel in the DAVB. Narrow junctions of parallel fascicles separate the AVN from the PAVB and DAVB. Myocytes, which are largest in DAVB, possess clear perinuclear regions; thin finger-like end processes, which are most numerous in the AVN; uniform, delicate cross-striations; and intercalated disks, which are broader in the PAVB and form short stacks in the AVN. Sheaves of nerve terminals, including boutons, are as found in skeletal muscle. Conclusions-The PAVB, AVN, and DAVB have distinct histological features. Collagen septation of primary and secondary fascicles presents natural barriers within the tissues and to surrounding myocardium and structures. These findings confirm that the AV junction region contains a specialized conduction system that is anatomically isolated from ordinary myocardium.

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Section: Points Of Controversymentioning

confidence: 99%

Section: Points Of Controversymentioning

confidence: 99%

Proximal Atrioventricular Bundle, Atrioventricular Node, and Distal Atrioventricular Bundle Are Distinct Anatomic Structures With Unique Histological Characteristics and Innervation

Racker

Kadish

2000

Circulation

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“…The inferior interatrial pathway activating the HRA via a specialized atrial pathway has been demonstrated. 1,[12][13][14] Recently, a human study by Asirvatham, et al 15) has shown that the musculature of the CS serves as a special conduction pathway such that a conduction wavefront during DCS pacing reaches the LA adjacent to the proximal CS first with subsequent LA activation in the opposite direction. Therefore, we proposed that in patients with paroxysmal AF (group 1), these pathways can be utilized during DCS pacing but not during HRA pacing.…”

Section: Discussionmentioning

confidence: 99%

“…Other than the interatrial Bachmann bundle, the LA is devoid of any specialized atrial pathway. 1,14) Therefore, conduction time from a HRA pacing site through LA musculature to the lateral LA should be longer than that from the DCS via the specialized atrial pathways to the HRA during DCS pacing in patients with paroxysmal AF. In contrast, the similar conduction delay between the HRA and the DCS during HRA pacing relative to during DCS pacing in patients without paroxysmal AF suggests that the specialized atrial pathways are used during both HRA and DCS pacing in these patients.…”

Section: Discussionmentioning

confidence: 99%

Atrial Electrophysiological Properties Evaluated by Right and Left Atrial Pacing in Patients with or without Atrial Fibrillation.

2002

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SUMMARYCoronary sinus (CS) pacing has been shown to prevent induction of atrial fibrillation (AF) by suppression of the propensity of atrial premature beats at high right atrium (HRA) to induce local conduction delay at the posterior triangle of Koch. However, other mechanisms of CS pacing in preventing induction of AF have not been explored. This study investigated whether a differential conduction delay exists between the HRA and distal CS pacing in patients with paroxysmal AF but not in patients without AF. Nine patients with atrioventricular reentrant tachycardia utilizing a left accessory pathway undergoing catheter ablation were included in this study. Group 1 consisted of 5 patients with clinically documented paroxysmal AF and group 2 4 patients without a history of AF. The effective refractory periods (ERPs) of HRA, distal CS, and four different left atrial sites were determined. The interatrial conduction time and conduction delay between the HRA and distal CS during HRA or distal CS pacing were measured. The interatrial conduction delay (ICD) from the HRA to the distal CS during HRA pacing was significantly longer than that from the distal CS to the HRA during distal CS pacing in patients of group 1. However, the ICD from the HRA to the distal CS during HRA pacing was not significantly longer than that from the distal CS to the HRA during distal CS pacing in group 2 patients. A differential conduction delay between the HRA and the distal CS pacing is present in this specific population of patients with paroxysmal AF but not in patients without AF. The shorter conduction delay during DCS pacing may contribute to the prevention of induction of AF. (Jpn Heart J 2002; 43: 231-240)

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“…Specific atrial pathways may exist [2,15,31,38,411 and may provide linear and accelerated impulse spread [13,411. The abnormal P waves found in patients in this study may have resulted from abnormal atrial pathways of conduction rather than abnormal origins of activation.…”

Section: Methodsmentioning

confidence: 99%

Abnormal Rhythms Associated with Persistent Left Superior Vena Cava

Momma

Linde

1969

Pediatr Res

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ExtractT h e electrocardiograms of 2 6 patients with persistent left superior vena cava ( S V C ) draining into t h e coronary sinus were reviewed. Left axis of P waves between + 15 a n d -29 degrees was observcd in nine cases, including t w o of three cases of persistent left SVC with absent right SI'C. Isorhythmic A-V dissociation with interference was observed in o n e subject.T h e study of t h e P wave i n five groups of patients with presumably normal caval drainage revealed t h a t frontal P wave axis fell usually between +20 a n d +70 degrees. SpeculationLeft axis of the P waves, if present i n patients with congenital h e a r t defects, m a y suggest persistent left superior vena cava draining to t h e coronary sinus. F u r t h e r pathologic a n d histologic study is needed to clarify t h e pathogenesis of these a b n o r m a l cardiac rhythms a n d t h e possible embryologic relation between persistent left superior v e n a cava a n d a n ectopic pacemaker.

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The connecting pathways between the sinus node and A-V node and between the right and the left atrium in the human heart

Cited by 401 publications

References 10 publications

Proximal Atrioventricular Bundle, Atrioventricular Node, and Distal Atrioventricular Bundle Are Distinct Anatomic Structures With Unique Histological Characteristics and Innervation

Proximal Atrioventricular Bundle, Atrioventricular Node, and Distal Atrioventricular Bundle Are Distinct Anatomic Structures With Unique Histological Characteristics and Innervation

Atrial Electrophysiological Properties Evaluated by Right and Left Atrial Pacing in Patients with or without Atrial Fibrillation.

Abnormal Rhythms Associated with Persistent Left Superior Vena Cava

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