Isolated heart conduction system showing atrioventricular node
Conduction system of the Heart (AV node labeled 2 on image)
|Artery||Atrioventricular nodal branch|
The atrioventricular (AV) node is a part of the electrical conduction system of the heart that coordinates the top of the heart. It electrically connects atrial and ventricular chambers. The AV node is an area of specialized tissue between the atria and the ventricles of the heart, specifically in the posteroinferior region of the interatrial septum near the opening of the coronary sinus, which conducts the normal electrical impulse from the atria to the ventricles. The AV node is quite compact (~1 x 3 x 5 mm). It is located at the center of Koch's triangle—a triangle enclosed by the septal leaflet of the tricuspid valve, the coronary sinus, and the membraneous part of the interatrial septum.
The blood supply of the AV node is via the AV nodal artery. The origin of this artery is most commonly (about 90% of hearts) a branch of the right coronary artery, with the remainder originating from the left circumflex artery. This is associated with the dominance of the coronary artery circulation. In right-dominant individuals the blood supply is from the right coronary artery while in left dominant individuals it originates from the left circumflex artery.
BMP (Bone morphogenetic protein) cell signaling plays a key role in diverse aspects of cardiac differentiation and morphogenesis. (BMPs) are multifunctional signaling molecules critical for the development of AV node. BMP influences AV node development through Alk3 receptor (Activin receptor-like kinase 3). Abnormalities seen in BMP and Alk3 are associated with some cardiovascular diseases like Ebstein’s anomaly and AV conduction disease.
Contraction of cardiomyocytes (heart muscle cells) requires depolarization and repolarization of their cell membranes. Movement of ions across cell membranes causes these events. The cardiac conduction system (and AV node part of it) coordinates myocyte mechanical activity. A wave of excitation spreads out from the sinoatrial node through the atria along specialized conduction channels. This activates the AV node. The atrioventricular node delays impulses by approximately 0.12s. This delay in the cardiac pulse is extremely important: It ensures that the atria have ejected their blood into the ventricles first before the ventricles contract.
AV conduction during normal cardiac rhythm occurs through two different pathways:
- the first “pathway” has a slow conduction velocity but shorter refractory period
- the second “pathway” has a faster conduction velocity but longer refractory period.
An important property that is unique to the AV node is decremental conduction, in which the more frequently the node is stimulated the slower it conducts. This is the property of the AV node that prevents rapid conduction to the ventricle in cases of rapid atrial rhythms, such as atrial fibrillation or atrial flutter.
The AV node's normal intrinsic firing rate without stimulation (such as that from the SA node) is 40-60 times/minute. This property is important because loss of the conduction system before the AV node should still result in pacing of the ventricles by the — slower — pacemaking ability of the AV node.
- Atrioventricular conduction disease (AV block) describes impairment of the electrical continuity between the atria and ventricles. It occurs when the atrial depolarization fail to reach the ventricles or is conducted with an abnormally long delay. It can result from an injury or be a genetically inherited disorder.
- Atrioventricular nodal re-entry tachycardia.
- Cystic tumour of atrioventricular nodal region (CTAVN) CTAVN is of endodermal origin and occurs exclusively in the area of the AV node, tricuspid valve, and interatrial septum.
- Gray, Huon H.; Keith D. Dawkins; Iain A. Simpson; John M. Morgan (2002). Lecture Notes on Cardiology. Boston: Blackwell Science. p. 135. ISBN 978-0-86542-864-5.
- Full Size Picture triangle of-Koch.jpg. Retrieved on 2008-12-22
- Harrison's Principles of Internal Medicine, 17e” Section 3: Disorders of Rhythm
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- Anatomy figure: 20:06-02 at Human Anatomy Online, SUNY Downstate Medical Center - "The conduction system of the heart."
- thoraxlesson4 at The Anatomy Lesson by Wesley Norman (Georgetown University) (thoraxheartinternalner)