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Anatomy of the conduction tissues 100 years on: what have we learned?
  1. Damián Sánchez-Quintana1,
  2. Robert H Anderson2,
  3. Justin T Tretter3,
  4. José Angel Cabrera4,
  5. Eduardo Back Sternick5,
  6. Jerónimo Farré6
  1. 1 Department of Anatomy and Cell Biology, Universidad de Extremadura, Badajoz, Spain
  2. 2 Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
  3. 3 Heart Institute, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
  4. 4 Department of Cardiology, Hospital Universitario Quirón-Madrid, European University of Madrid, Madrid, Spain
  5. 5 Department of Arrhythmia and Electrophysiology, Biocor Institute, Nova Lima, Brazil
  6. 6 Madrid Autonomous University, Fundación Jiménez Díaz Hospital, Madrid, Spain
  1. Correspondence to Professor Robert H Anderson, 60 Earlsfield Road, London SW18 3DN, UK; sejjran{at}


Knowledge of the anatomy of the ‘conduction tissues’ of the heart is a 20th century phenomenon. Although controversies still continue on the topic, most could have been avoided had greater attention been paid to the original descriptions. All cardiomyocytes, of course, have the capacity to conduct the cardiac impulse. The tissues specifically described as ‘conducting’ first generate the cardiac impulse, and then deliver it in such a fashion that the ventricles contract in orderly fashion. The tissues cannot readily be distinguished by gross inspection. Robust definitions for their recognition had been provided by the end of the first decade of the 20th century. These definitions retain their currency. The sinus node lies as a cigar-shaped structure subepicardially within the terminal groove. There is evidence that it is associated with a paranodal area that may have functional significance. Suggestions of dual nodes, however, are without histological confirmation. The atrioventricular node is located within the triangle of Koch, with significant inferior extensions occupying the atrial vestibules and with septal connections. The conduction axis penetrates the insulating plane of the atrioventricular junctions to continue as the ventricular pathways. Remnants of a ring of cardiomyocytes observed during development are also to be found within the atrial vestibules, particularly a prominent retroaortic remnant, although that their role has still to be determined. Application of the initial criteria for nodes and tracts shows that there are no special ‘conducting tissues’ in the pulmonary venous sleeves that might underscore the abnormal rhythm of atrial fibrillation.

  • arrhythmias
  • cardiac
  • tachycardia
  • supraventricular
  • electrophysiology

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  • Contributors All of the authors made significant contributions to the topics reviewed. All of the authors contributed to the writing of the review and reviewed the final version of the text. All of the authors have made significant intellectual contributions to the topics discussed.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Commissioned; externally peer reviewed.