Structure, function and clinical relevance of the cardiac conduction system, including the atrioventricular ring and outflow tract tissues

Dobrzynski, Halina, Anderson, Robert H., Atkinson, Andrew, Borbas, Zoltan, D'Souza, Alicia, Fraser, John F., Inada, Shin, Logantha, Sunil J. R. J., Monfredi, Oliver, Morris, Gwilym M., Moorman, Anton F. M., Nikolaidou, Thodora, Schneider, Heiko, Szuts, Viktoria, Temple, Ian P., Yanni, Joseph and Boyett, Mark R. (2013) Structure, function and clinical relevance of the cardiac conduction system, including the atrioventricular ring and outflow tract tissues. Pharmacology and Therapeutics, 139 2: 260-288. doi:10.1016/j.pharmthera.2013.04.010


Author Dobrzynski, Halina
Anderson, Robert H.
Atkinson, Andrew
Borbas, Zoltan
D'Souza, Alicia
Fraser, John F.
Inada, Shin
Logantha, Sunil J. R. J.
Monfredi, Oliver
Morris, Gwilym M.
Moorman, Anton F. M.
Nikolaidou, Thodora
Schneider, Heiko
Szuts, Viktoria
Temple, Ian P.
Yanni, Joseph
Boyett, Mark R.
Title Structure, function and clinical relevance of the cardiac conduction system, including the atrioventricular ring and outflow tract tissues
Journal name Pharmacology and Therapeutics   Check publisher's open access policy
ISSN 0163-7258
1879-016X
Publication date 2013-08
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1016/j.pharmthera.2013.04.010
Volume 139
Issue 2
Start page 260
End page 288
Total pages 29
Editor P. Molenaar
Place of publication Philadelphia, PA United States
Publisher Elsevier
Collection year 2014
Language eng
Formatted abstract
It is now over 100 years since the discovery of the cardiac conduction system, consisting of three main parts, the sinus node, the atrioventricular node and the His–Purkinje system. The system is vital for the initiation and coordination of the heartbeat. Over the last decade, immense strides have been made in our understanding of the cardiac conduction system and these recent developments are reviewed here. It has been shown that the system has a unique embryological origin, distinct from that of the working myocardium, and is more extensive than originally thought with additional structures: atrioventricular rings, a third node (so called retroaortic node) and pulmonary and aortic sleeves. It has been shown that the expression of ion channels, intracellular Ca2+-handling proteins and gap junction channels in the system is specialised (different from that in the ordinary working myocardium), but appropriate to explain the functioning of the system, although there is continued debate concerning the ionic basis of pacemaking. We are beginning to understand the mechanisms (fibrosis and remodelling of ion channels and related proteins) responsible for dysfunction of the system (bradycardia, heart block and bundle branch block) associated with atrial fibrillation and heart failure and even athletic training. Equally, we are beginning to appreciate how naturally occurring mutations in ion channels cause congenital cardiac conduction system dysfunction. Finally, current therapies, the status of a new therapeutic strategy (use of a specific heart rate lowering drug) and a potential new therapeutic strategy (biopacemaking) are reviewed.
Keyword Cardiac conduction system
Atrioventricular ring tissue
Right ventricular outflow tract
Arrhythmias
Biopacemaking
Channelopathies
Sinus node dysfunction
Long-QT syndrome
Focal atrial tachycardia
Canine purkinje-fibers
Rabbit sinoatrial node
Heart-rate reduction
Bundle-branch-block
Torsades-de-pointes
Channel gene SCN5A
Pace-maker current
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2014 Collection
School of Medicine Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 30 times in Thomson Reuters Web of Science Article | Citations
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