conduction system of the heart pdf basics

Up to now, this information has been absent from the literature.īiophysically-detailed mathematical models are powerful tools with which to investigate normal and pathological cardiac conduction. Knowledge of the 3D micro-anatomy of the human cardiac conduction system, therefore, is crucial. We have shown previously the 3D distribution of the cardiac conduction system in animal hearts 9, 10, 11, 12, along with the link between its molecular and micro-anatomical remodelling in disease 13. The onset of such conditions may be attributed to age, genetic predisposition, lifestyle, myocardial remodelling, fibrosis of tissues, and history of surgical procedures. They also occur in almost 40% of patients attending cardiology outpatient clinics 7. The main components of the cardiac conduction system are the sinus node of the right atrium, which is the primary pacemaker the atrioventricular conduction axis, which normally forms the only pathway allowing excitation to pass between the atria and ventricles and the Purkinje network, which allows fast and coordinated conduction within the ventricles 3, 4.Ĭardiac arrhythmias and conduction disturbances affect 0.1% of adults younger than 55 years old, increasing to 9% in those older than 80 years 5, 6, 7, 8. They act also to conduct impulses throughout the heart, in a rapid and coordinated fashion 1. They have the ability spontaneously to generate electrical impulses and to function as pacemakers 1, 2. The specialised cardiomyocytes, known as the cardiac conduction system, are anatomically discrete from the working myocardium, and cannot be visualised using traditional non-invasive techniques. Such data presented as 3D images or 3D printed models, will inform discussions between medical teams and their patients, and aid the education of medical and surgical trainees.

We also offer a practical method for investigation of remodelling in disease, and thus, virtual pathology and archiving. By showing the precise 3-dimensional relationships between the cardiac conduction system and surrounding structures, we provide new insights relevant to valvar replacement surgery and ablation therapies. Since the rate of depolarisation is dictated by cardiac microstructure, and the precise orientation of the cardiomyocytes, our data should improve the fidelity of mathematical models. The data presented should have multidisciplinary impact. We have incorporated the high-resolution anatomical data into mathematical simulations of cardiac electrical depolarisation. These data show that commonly accepted anatomical representations are oversimplified. We show that cardiomyocyte orientation can be extracted from these datasets at spatial resolutions approaching the single cell. Here, using contrast enhanced micro-computed tomography, we present, in attitudinally appropriate fashion, the first 3-dimensional representations of the cardiac conduction system within the intact human heart. Cardiac arrhythmias and conduction disturbances are accompanied by structural remodelling of the specialised cardiomyocytes known collectively as the cardiac conduction system.

Conduction system of the heart pdf basics