Cited by 106Cardiac electrophysiology and arrhythmiasCardiac Arrhythmias and TreatmentsCardiac pacing and defibrillation studies

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Conduction barriers and pathways of the sinoatrial pacemaker complex: their role in normal rhythm and atrial arrhythmias

Fedorov, Vadim V., Glukhov, Alexey V., Chang, Roger·2012·American Journal of Physiology-Heart and Circulatory Physiology

DOI 10.1152/ajpheart.00892.2011

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Abstract

Since Keith and Flack's anatomical discovery of the sinoatrial node (SAN), the primary pacemaker of the heart, the question of how such a small SAN structure can pace the entire heart has remained for a large part unanswered. Recent advances in optical mapping technology have made it possible to unambiguously resolve the origin of excitation and conduction within the animal and human SAN. The combination of high-resolution optical mapping and histological structural analysis reveals that the canine and human SANs are functionally insulated from the surrounding atrial myocardium, except for several critical conduction pathways. Indeed, the SAN as a leading pacemaker requires anatomical (fibrosis, fat, and blood vessels) and/or functional barriers (paucity of connexins) to protect it from the hyperpolarizing influence of the surrounding atrium. The presence of conduction barriers and pathways may help explain how a small cluster of pacemaker cells in the SAN pacemaker complex manages to depolarize different, widely distributed areas of the right atria as evidenced functionally by exit points and breakthroughs. The autonomic nervous system and humoral factors can further regulate conduction through these pathways, affecting pacemaker automaticity and ultimately heart rate. Moreover, the conduction barriers and multiple pathways can form substrates for reentrant activity and thus lead to atrial flutter and fibrillation. This review aims to provide new insight into the function of the SAN pacemaker complex and the interaction between the atrial pacemakers and the surrounding atrial myocardium not only in animal models but also human hearts.

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Glukhov AV, 2011, Circulation, 124, A9272, 10.1161/circ.124.suppl_21.A9272 · DOI
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Authors: Fedorov, V. V., Glukhov, A. V., & Chang, R.
Affiliations: The Ohio State University Wexner Medical Center (US)
Corresponding author: Fedorov, Vadim V.
ORCID: Fedorov, Vadim V.
Glukhov, Alexey V.
Chang, Roger
Venue: American Journal of Physiology-Heart and Circulatory Physiology
Publisher: American Physiological Society
Published: 2012-05-01
Volume: 302
Issue: 9
Pages: H1773-H1783
ISSN: 0363-6135 (ISSN-L)
1522-1539
DOI: 10.1152/ajpheart.00892.2011
OpenAlex: W1991705453
Cited by: 106
References: 54
Citations by year: 2026: 6 · 2025: 3 · 2024: 6 · 2023: 5 · 2022: 10 · 2021: 10 · 2020: 6 · 2019: 7 · 2018: 8 · 2017: 9 · 2016: 6 · 2015: 12 · 2014: 7 · 2013: 9 · 2012: 2
FWCI: 1.57
Type: journal article
Language: en
Open access: closed
Locations: American Journal of Physiology-Heart and Circulatory Physiology (publishedVersion)
PubMed (publishedVersion)
Funders: Heart Research Institute
Dorothy M. Davis Heart and Lung Research Institute
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, conductive pathways, atrial arrhythmias, atrial flutter, atrial fibrillation, reentry, optical mapping, connexins, atrial fibrosis, heart rate regulation, atrial pacemaker
MeSH terms: Animals, Arrhythmias, Cardiac, Autonomic Nervous System, Dogs, Heart Conduction System, Heart Rate, Humans, Sinoatrial Node, Atrial Function, Models, Animal

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Conduction barriers and pathways of the sinoatrial pacemaker complex: their role in normal rhythm and atrial arrhythmias

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