Differentiation of the Atrioventricular Conducting System of the Heart

The structure and function of the atrioventricular conducting system of the heart, and its relationship to the myocardium, are examined from a developmental point of view. On the basis of information derived from electron micrographic, electrophysiologic, and developmental studies of heart tissue, it is concluded that: (1) The idea of the syncytial nature of the heart lacks a sound anatomic basis. (2) Cytodifferentiation during embryonic cardiogenesis results in the development of at least 2 distinct populations of cells: those comprising the bulk of the myocardium and a second type, the specialized cells of the conductive tissue, which differs in histology, biochemistry, and physiology. (3) The common view of the myocardium as a spontaneously active tissue may require revision, since several lines of evidence appear to indicate that myocardial cells are quiescent until stimulated by an extrinsic source. Under normal circumstances, this stimulus source is the conductive tissue.