Structure, function and clinical relevance of the cardiac conduction system, including the atrioventricular ring and outflow tract tissues

Halina Dobrzynski, Robert H. Anderson, Andrew Atkinson, Zoltan Borbas, Alicia D'Souza, John F. Fraser, Shin Inada, Sunil J.R.J. Logantha, Oliver Monfredi, Gwilym M. Morris, Anton F.M. Moorman, Thodora Nikolaidou, Heiko Schneider, Viktoria Szuts, Ian P. Temple, Joseph Yanni, Mark R. Boyett

Research output: Contribution to journalReview article

74 Citations (Scopus)

Abstract

It is now over 100 years since the discovery of the cardiac conduction system, consisting of three main parts, the sinus node, the atrioventricular node and the His-Purkinje system. The system is vital for the initiation and coordination of the heartbeat. Over the last decade, immense strides have been made in our understanding of the cardiac conduction system and these recent developments are reviewed here. It has been shown that the system has a unique embryological origin, distinct from that of the working myocardium, and is more extensive than originally thought with additional structures: atrioventricular rings, a third node (so called retroaortic node) and pulmonary and aortic sleeves. It has been shown that the expression of ion channels, intracellular Ca2+-handling proteins and gap junction channels in the system is specialised (different from that in the ordinary working myocardium), but appropriate to explain the functioning of the system, although there is continued debate concerning the ionic basis of pacemaking. We are beginning to understand the mechanisms (fibrosis and remodelling of ion channels and related proteins) responsible for dysfunction of the system (bradycardia, heart block and bundle branch block) associated with atrial fibrillation and heart failure and even athletic training. Equally, we are beginning to appreciate how naturally occurring mutations in ion channels cause congenital cardiac conduction system dysfunction. Finally, current therapies, the status of a new therapeutic strategy (use of a specific heart rate lowering drug) and a potential new therapeutic strategy (biopacemaking) are reviewed.

Original languageEnglish
Pages (from-to)260-288
Number of pages29
JournalPharmacology and Therapeutics
Volume139
Issue number2
DOIs
Publication statusPublished - Aug 1 2013

Keywords

  • Arrhythmias
  • Atrioventricular ring tissue
  • Biopacemaking
  • Cardiac conduction system
  • Channelopathies
  • Right ventricular outflow tract

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

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  • Cite this

    Dobrzynski, H., Anderson, R. H., Atkinson, A., Borbas, Z., D'Souza, A., Fraser, J. F., Inada, S., Logantha, S. J. R. J., Monfredi, O., Morris, G. M., Moorman, A. F. M., Nikolaidou, T., Schneider, H., Szuts, V., Temple, I. P., Yanni, J., & Boyett, M. R. (2013). Structure, function and clinical relevance of the cardiac conduction system, including the atrioventricular ring and outflow tract tissues. Pharmacology and Therapeutics, 139(2), 260-288. https://doi.org/10.1016/j.pharmthera.2013.04.010