Structure-function relationship in the sinus and atrioventricular nodes
Open accessAbstract
Recently published optical mapping studies of larger mammals, including humans, have identified functionally discrete sinoatrial exit pathways of activation. This is in line with earlier mapping studies of the dog and the human but in contrast with findings in the mouse and the rabbit, wherein a propagation wave front pattern of activation has been described. It underpins the complex three-dimensional (3D) organization of the cardiac pacemaking and conduction system in larger species, wherein sinoatrial and atrioventricular nodal physiologies both demonstrate identifiable activation pathways, which coincide with anatomic landmarks and histologic architecture, so that in addition to muscle fiber orientation and cell coupling, these intrinsic factors act to determine excitation pathways. This complex 3D organization increases the effect of source-to-sink mismatch both by greater variability in the space constant of tissue and by the 3D projection of this effect in all directions. Mathematical modeling provides a means to study these interactions, and newer models should incorporate these additional factors and their effect into the 3D structure of large mammal physiology.
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The AV node is a three-dimensional structure with greater variability in tissue space constant and poor gap junction connectivity due to differential connexin isoform expression, conditions that explain dual conduction and nodal reentrant arrhythmogenesis.
“The AV node is a three-dimensional structure with greater variability in the space constant of tissue, and poor gap junction connectivity due to differential expression of connexin isoforms, conditions that provide an explanation of dual conduction and nodal reentrant arrhythmogenesis.218,219”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [218]
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- Authors
- Nikolaidou, T., Aslanidi, O. V., Zhang, H., & Efimov, I. R.
- Affiliations
- Washington University in St. Louis (US)
- King's College London (GB)
- University of Manchester (GB)
- Corresponding author
- Nikolaidou, T.
- Venue
- Pediatric Cardiology
- Published
- 2012-03-03
- Volume
- 33
- Issue
- 6
- Pages
- 890-899
- ISSN
- 0172-0643 (ISSN-L)
- 1432-1971
- PMC
- PMC3703519
- OpenAlex
- W2151460548
- Cited by
- 47
- References
- 69
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3 · 2023: 4 · 2022: 3 · 2021: 4 · 2020: 2 · 2019: 8 · 2018: 1 · 2017: 3 · 2016: 3 · 2015: 3 · 2014: 6 · 2013: 2 · 2012: 3
- FWCI
- 2.85
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Pediatric Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- National Institute for Health and Care Research (ACF-2007-06-003)
- British Heart Foundation (PG/10/69/28524)
- National Heart, Lung, and Blood Institute (R01HL114395)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- sinoatrial node, atrioventricular node, cardiac pacemaking, cardiac conduction system, structure-function relationship, optical mapping, space constant, tissue anisotropy
- MeSH terms
- Animals, Atrioventricular Node, Computer Simulation, Humans, Models, Cardiovascular, Sinoatrial Node
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