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Anatomy and Physiology of the Atrioventricular Node: What Do We Know Today?

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Cardiac Arrhythmias

Abstract

Atrioventricular (AV) node consists of a part of the sole pathway of impulse conduction from the atria to the ventricles. It becomes the base of occurrence and maintenance of various arrhythmias involving this region by special electrophysiological characters as follows: The conduction across the node is quite slow, it functions as two separated conductors with property of fast or slow conduction, and it has the automaticity. AV junctional area including the node itself potentially works as the ectopic center of a subsidiary pacemaker when the sinus node as the primary pacemaker fails to control the cardiac rhythm. Muscular bundles consisting of dual AV pathways are not anatomically distinguished but can be functionally differentiated by the difference of conduction property and refractoriness. A fast pathway connects with the center of the node from anterior part of interatrial septum, and a slow pathway does from posteroinferior area to the tricuspid valve. In cells of slow pathway, the occurrence of automaticity is determined and the expression of ion channels is similar to ones in the center of the node. These facts suggest that the dual-pathway physiology of the AV node is not only formed by special electrophysiological property of cells but based on the morphology.

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Abbreviations

AN:

Atrio-nodal

AP:

Action potential

AV:

Atrioventricular

AVNRT:

Atrioventricular nodal reentrant tachycardia

CS:

Coronary sinus

Cx:

Connexin

DAVNP:

Dual atrioventricular nodal pathway

FP:

Fast pathway

I Ca,L :

L-type calcium channel current

I Ca,T :

T-type calcium channel current

I K1 :

Inward rectifier potassium current

IVC:

Inferior vena cava

MV:

Mitral valve

NH:

Nodo-His

PNE:

Posterior nodal extension

RA:

Right atrium

RV:

Right ventricle

SP:

Slow pathway

TV:

Tricuspid valve

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan

    Hidekazu Miyazaki MD, PhD, CCDS

  2. Department of Cardiology, Kawasaki Municipal Tama Hospital, 1-30-37, Syukugawara, Tama-ward, Kawasaki, Kanagawa, 214-8525, Japan

    Hidekazu Miyazaki MD, PhD, CCDS

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  1. Hidekazu Miyazaki MD, PhD, CCDS
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Correspondence to Hidekazu Miyazaki MD, PhD, CCDS .

Editor information

Editors and Affiliations

  1. Department of Cardiology, Center Hospitalier Coutances, Coutances, France

    Ambrose S. Kibos

  2. Department of Internal Medicine Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA

    Bradley P. Knight

  3. Division of Cardiology, McGill University Health Center, Montreal, Québec, Canada

    Vidal Essebag

  4. Department of Cardiology, Miami Children's Hospital, Miami, Florida, USA

    Steven B. Fishberger

  5. School of Biology, Chemistry and Health, Manchester Metropolitan University, Manchester, United Kingdom

    Mark Slevin

  6. “Acad. Vasile Candea” Emergency Clinical Center for Cardiovascular Diseases, “Carol Davila” University of Medicine and Pharmacy, “Titu Maiorescu” University Faculty of Medicine,, Bucharest, Romania

    Ion C. Țintoiu

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Miyazaki, H. (2014). Anatomy and Physiology of the Atrioventricular Node: What Do We Know Today?. In: Kibos, A., Knight, B., Essebag, V., Fishberger, S., Slevin, M., Țintoiu, I. (eds) Cardiac Arrhythmias. Springer, London. https://doi.org/10.1007/978-1-4471-5316-0_2

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  • DOI: https://doi.org/10.1007/978-1-4471-5316-0_2

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