Anatomy of the Atrioventricular Node and Atrioventricular Conduction System

The anatomy of the atrioventricular conduction system was first described nearly a hundred years ago. Since then, it has been an occasional subject of controversy mainly through a lack of adherence to the original definitions based on histology. The gross landmarks for locating the atrial component of the conduction system are found in the right atrium. The components and structure of the system in human are comparable to that found in commonly used laboratory animals. The conduction system is composed of specialized myocytes. Its atrial component, the atrioventricular node, is in contact with atrial myocardium. Having penetrated the atrioventricular insulating plane, the major ventricular bundles are encased in fibrous sheaths that separate the specialized myocytes from the ordinary myocardium. Only at the distal ramifications of the bundle branches do the fibrous sheaths disappear, allowing continuity with ventricular myocardium. Being the only muscular pathway connecting atrial with ventricular myocardium, knowledge of its structure can help in developing potential therapies for some forms of cardiac arrhythmias.