Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Surgical and Electrical Anatomy of the Inter-Nodal and Intra-Atrial Conduction System in the Heart

  • Seo, Jeong-Wook (Department of Pathology, Incheon Sejong Hospital) ;
  • Kim, Jung-Sun (Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Cha, Myung-Jin (Heart Institute, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yoon, Ja Kyoung (Department of Pediatrics, Bucheon Sejong Hospital) ;
  • Kim, Min-Ju (Department of Pathology, Incheon Sejong Hospital) ;
  • Tsao, Hsuan-Ming (Department of Internal Medicine, National Yang Ming Chiao Tung University and NYCU Hospital) ;
  • Lee, Chang-Ha (Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital) ;
  • Oh, Seil (Cardiac Electrophysiology Lab Seoul National University Cardiovascular Center, Department of Internal Medicine, Seoul National University)
  • Received : 2022.04.20
  • Accepted : 2022.06.24
  • Published : 2022.10.05
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Abstract

An anatomical understanding of the atrial myocardium is crucial for surgeons and interventionists who treat atrial arrhythmias. We reviewed the anatomy of the inter-nodal and intra-atrial conduction systems. The anterior inter-nodal route (#1) arises from the sinus node and runs through the ventral wall of the atrial chambers. The major branch of route #1 approaches the atrioventricular node from the anterior aspect. Other branches of route #1 are Bachmann's bundle and a vestibular branch around the tricuspid valve. The middle inter-nodal route (#2) begins with a broad span of fibers at the sinus venarum and extends to the superior limbus of the oval fossa. The major branch of route #2 joins with the branch of route #1 at the anterior part of the atrioventricular node. The posterior inter-nodal route (#3) is at the terminal crest and gives rise to many branches at the pectinate muscles of the right atrium and then approaches the posterior atrioventricular node after joining with the vestibular branch of route #1. The branches of the left part of Bachmann's bundle and the branches of the second inter-nodal route form a thin myocardial network at the posterior wall of the left atrium. These anatomical structures could be categorized into major routes and side branches. There are 9 or more anatomical circles in the atrial chambers that could be structural sites for macro re-entry. The implications of normal and abnormal structures of the myocardium for the pathogenesis and treatment of atrial arrhythmias are discussed.

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