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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2022. For permissions, please email: journals.permissions@oup.com. 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.
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
URL: https://doi.org/10.1093/europace/euab287
DOI: 10.1093/europace/euab287
PubMed id: 34999831
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