Atrioventricular node

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Atrioventricular node

Isolated heart conduction system showing atrioventricular node

Conduction system of the Heart

Details

Latin

Nodus atrioventricularis

Artery

Atrioventricular nodal branch

Identifiers

Dorlands

n_09/12576113

/Elsevier

TA

A12.1.06.004

FMA

FMA:9478

Anatomical terminology

The atrioventricular node (abbreviated AV node) is a part of the electrical control system of the
heart that coordinates the top of the heart. It electrically connects atrial and ventricular
chambers.[1] The AV node is an area of specialized tissue between the atriaand the ventricles of
the heart, specifically in the posteroinferior region of the interatrial septum near the opening of
the coronary sinus, which conducts the normal electrical impulse from the atria to the ventricles. The
AV node is quite compact (~1 x 3 x 5 mm).[2]It is located at the center of Koch's Trianglea triangle
enclosed by the septal leaflet of the tricuspid valve, the coronary sinus, and the membraneous part
of the interatrial septum.[3]
Contents
[hide]

1 Structure
o 1.1 Blood supply
o 1.2 Development
2 Function
3 Clinical relevance
4 See also
5 References
6 External links

Structure[edit]
The AV node receives two inputs from the atria: posteriorly, via the crista terminalis, and anteriorly,
via the interatrial septum.[4]

Blood supply[edit]
The blood supply of the AV node is via the AV nodal artery. The origin of this artery is most
commonly (about 90% of hearts) a branch of the right coronary artery, with the remainder originating
from the left circumflex artery.[5][6][7] This is associated with thedominance of the coronary artery
circulation. In right-dominant individuals the blood supply is from the right coronary artery while in left
dominant individuals it originates from the left circumflex artery.

Development[edit]
BMP (Bone morphogenetic protein) cell signaling plays a key role in diverse aspects of cardiac
differentiation and morphogenesis. (BMPs) are multifunctional signaling molecules critical for the
development of AV node. BMP influences AV node development through Alk3 receptor (Activin
receptor-like kinase 3). Abnormalities seen in BMP and Alk3 are associated with some
cardiovascular diseases like Ebsteins anomaly and AV conduction disease.[8]

Function[edit]
Contraction of myocytes (heart muscle cells) requires depolarization and repolarization of their cell
membranes. Movement of ions across cell membranes causes these events. The cardiac
conduction system (and AV node part of it) coordinates myocyte mechanical activity. A wave of
excitation spreads out from the sinoatrial node through the atria along specialized conduction
channels. This activates the AV node.[1] The atrioventricular node delays impulses by approximately
0.12s. This delay in the cardiac pulse is extremely important: It ensures that the atria have ejected
their blood into the ventricles first before the ventricles contract.[9]
This also protects the ventricles from excessively fast rate response to atrial arrhythmias (see
below).[10]
AV conduction during normal cardiac rhythm occurs through two different pathways:

the first pathway has a slow conduction velocity but shorter refractory period
the second pathway has a faster conduction velocity but longer refractory period.[11]

An important property that is unique to the AV node is decremental conduction,[12] in which the more
frequently the node is stimulated the slower it conducts. This is the property of the AV node that
prevents rapid conduction to the ventricle in cases of rapid atrial rhythms, such as atrial
fibrillation or atrial flutter.
The AV node's normal intrinsic firing rate without stimulation (such as that from the SA node) is 4060 times/minute.[13]

Clinical relevance[edit]

Atrioventricular conduction disease (AV block) describes impairment of the electrical continuity
between the atria and ventricles. It occurs when the atrial depolarization fail to reach the
ventricles or is conducted with a delay. It can result from an injury or be a genetically inherited
disorder.[14]
Atrioventricular nodal re-entry tachycardia.[11]
Cystic tumour of atrioventricular nodal region (CTAVN) CTAVN is of endodermal origin and
occurs exclusively in the area of the AV node, tricuspid valve, and interatrial septum.[15]

See also[edit]
This article uses anatomical terminology; for an overview, see anatomical terminology.

Electrical conduction system of the heart

Sinoatrial node (SA node)

References[edit]

1. ^ Jump up to:a b Gray, Huon H.; Keith D. Dawkins, Iain A. Simpson and John M. Morgan
(2002). Lecture Notes on Cardiology. Boston: Blackwell Science. p. 135. ISBN 978-0-86542864-5.
2. Jump up^ Full Size Picture triangle of-Koch.jpg. Retrieved on 2008-12-22
3. Jump up^ Harrison's Principles of Internal Medicine, 17e Section 3: Disorders of Rhythm
4. Jump up^ Fuster V, Rydn LE, Asinger RW, et al. (October 2001). "ACC/AHA/ESC
guidelines for the management of patients with atrial fibrillation". Journal of the American
College of Cardiology38 (4): 123166. doi:10.1016/S0735-1097(01)01587X. PMID 11583910.
5. Jump up^ Van der Hauwaert LG, Stroobandt R, Verhaeghe L (October 1972). "Arterial
blood supply of the atrioventricular node and main bundle". British Heart Journal 34 (10):
104551.doi:10.1136/hrt.34.10.1045. PMC 458545. PMID 5086972.
6. Jump up^ Pejkovi, B.; Krajnc, I.; Anderhuber, F.; Kosuti, D. (2008). "Anatomical aspects
of the arterial blood supply to the sinoatrial and atrioventricular nodes of the human
heart". The Journal of international medical research 36 (4): 691
698. doi:10.1177/147323000803600410. PMID 18652764. edit
7. Jump up^ Saremi, F.; Abolhoda, A.; Ashikyan, O.; Milliken, J. C.; Narula, J.; Gurudevan, S.
V.; Kaushal, K.; Raney, A. (2007). "Arterial Supply to Sinuatrial and Atrioventricular Nodes:
Imaging with Multidetector CT". Radiology 246 (1): 99107; discussion 108
9. doi:10.1148/radiol.2461070030. PMID 18024438. edit
8. Jump up^ Stroud DM, Gaussin V, Burch JB, et al. (November 2007). "Abnormal Conduction
and Morphology in the Atrioventricular Node of Mice With Atrioventricular CanalTargeted
Deletion of Alk3/Bmpr1a Receptor". Circulation 116 (22): 2535
43. doi:10.1161/CIRCULATIONAHA.107.696583. PMC 2947829. PMID 17998461.
9. Jump up^ Campbell, N., & Reece, J. (2002). Biology. 6th ed. San Francisco: Benjamin
Cummings[page needed]
10. Jump up^ Gray, Huon H.; Keith D. Dawkins, Iain A. Simpson and John M. Morgan
(2002). Lecture Notes on Cardiology. Boston: Blackwell Science. p. 136. ISBN 978-0-86542864-5.
11. ^ Jump up to:a b Gray, Huon H.; Keith D. Dawkins, Iain A. Simpson and John M. Morgan
(2002). Lecture Notes on Cardiology. Boston: Blackwell Science. p. 157. ISBN 978-0-86542864-5.
12. Jump up^ Patterson E, Scherlag BJ (October 2002). "Decremental conduction in the
posterior and anterior AV nodal inputs". Journal of Interventional Cardiac
Electrophysiology 7 (2): 13748.doi:10.1023/A:1020833604423. PMID 12397223.
13. Jump up^ Guyton, Arthur C.; John E. Hall (2006). Textbook of Medical Physiology (11 ed.).
Philadelphia: Elsevier Saunders. p. 120. ISBN 0-7216-0240-1.
14. Jump up^ Benson DW (October 2004). "Genetics of atrioventricular conduction disease in
humans". The Anatomical Record. Part A: Discoveries in Molecular, Cellular, and
Evolutionary Biology 280 (2): 9349. doi:10.1002/ar.a.20099. PMID 15372490.
15. Jump up^ Sharma G, Linden MD, Schultz DS, Inamdar KV (January 2009). "Cystic tumor of
the atrioventricular node: an unexpected finding in an explanted heart". Cardiovascular
Pathology : the Official Journal of the Society for Cardiovascular Pathology 19 (3): e75
8. doi:10.1016/j.carpath.2008.10.011. PMID 19144541.