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Miniseries 1 - Part I: the Development of the atrioventricular conduction axis

Lookup NU author(s): Professor Bob Anderson


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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2022. For permissions, please email: Despite years of research, many details of the formation of the atrioventricular conduction axis remain uncertain. In this study, we aimed to clarify the situation. We studied three-dimensional reconstructions of serial histological sections and episcopic datasets of human embryos, supplementing these findings with assessment of material housed at the Human Developmental Biological Resource. We also examined serially sectioned human foetal hearts between 10 and 30 weeks of gestation. The conduction axis originates from the primary interventricular ring, which is initially at right angles to the plane of the atrioventricular canal, with which it co-localizes in the lesser curvature of the heart loop. With rightward expansion of the atrioventricular canal, the primary ring bends rightward, encircling the newly forming right atrioventricular junction. Subsequent to remodelling of the outflow tract, part of the primary ring remains localized on the crest of the muscular ventricular septum. By 7 weeks, its atrioventricular part has extended perpendicular to the septal parts. The atrioventricular node is formed at the inferior transition between the ventricular and atrial parts, with the transition itself marking the site of the penetrating atrioventricular bundle. Only subsequent to muscularization of the true second atrial septum does it become possible to recognize the definitive node. The conversion of the developmental arrangement into the definitive situation as seen postnatally requires additional remodelling in the first month of foetal development, concomitant with formation of the inferior pyramidal space and the infero-septal recess of the subaortic outflow tract.

Publication metadata

Author(s): Hikspoors JPJM, Macias Y, Tretter JT, Anderson RH, Lamers WH, Mohun TJ, Sanchez-Quintana D, Farre J, Back Sternick E

Publication type: Article

Publication status: Published

Journal: EP Europace

Year: 2022

Volume: 24

Issue: 3

Pages: 432-442

Print publication date: 01/03/2022

Online publication date: 06/01/2022

Acceptance date: 02/11/2021

ISSN (print): 1099-5129

ISSN (electronic): 1532-2092

Publisher: Oxford University Press


DOI: 10.1093/europace/euab287

PubMed id: 34999831


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