Skip to main content
SpringerLink
Log in

Atrial and Atrioventricular Junctional Anatomy: Myocardial Orientation and Its Heterogeneity

  • Chapter
  • First Online:
Catheter Ablation

Abstract

Recent electrophysiological studies suggested that the left and right atrial posterior wall originated ectopic beats and functioned as anatomical substrates. For example, the right atrial posterior wall harbors the terminal crest, sinoatrial node, and coronary sinus opening. In the left atrium, four pulmonary vein openings should be designated. Distribution of these anatomical structures must to be known as a landmark for catheter ablation procedure. In addition, atrial fibrillation (AF) increase in its incidence after middle-age, age-related changes in atrial wall should be counted. Differently from AF, atrial tachycardia (AT) that arose from atrioventricular (AV) junctional tissue seems to be even more uncomplicated, because most of the substrates are regarded as the remnant of embryonal AV nodal tissue. Interestingly, a recent study reported the maldistribution of AT foci between the left and right AV annulus. In the tricuspid annulus, AT foci show diffuse distribution, but in the mitral annulus prevail mainly on right and left fibrous trigone. This phenomenon seems to be resonant with recent report of superior AV nodal reentrant tachycardia mainly subjected on the right fibrous trigone. This chapter maintains these phenomena concomitantly with distribution of nodal tissue on AV annuli. In addition, we mention concerning about the connection of right and left atria, mainly composed with Bachmann’s bundle and coronary sinus musculature. These myocardial arrangements may explain various electrophysiological phenomena inevitably brought from one atrium to another. We wish this chapter may contribute to the improvement of catheter technique and reduction of complications.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Keith A, Flack M. The form and nature of the muscular connections between the primary divisions of the vertebrate heart. J Anat Physiol. 1907;41:172–87.

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Anderson KR, Ho SY, Anderson RH. Location and vascular supply of sinus node in human heart. Br Heart J. 1979;41:28–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Inoue S, Shinohara F, Niitani H, Gotoh K. A new method for the histological study of aging changes in the sinoatrial node. Jpn Heart J. 1986;27:653–60.

    Article  CAS  PubMed  Google Scholar 

  4. Matsuyama TA, Inoue S, Kobayashi Y, et al. Anatomical diversity and age-related histological changes in the human right atrial posterolateral wall. Europace. 2004;6:307–15.

    Article  PubMed  Google Scholar 

  5. Boineau JP, Canavan TE, Schuessler RB, et al. Demonstration of a widely distributed atrial pacemaker complex in the human heart. Circulation. 1988;77:1221–37.

    Article  CAS  PubMed  Google Scholar 

  6. Kistler PM, Roberts-Thomson KC, Haqqani HM, et al. P-wave morphology in focal atrial tachycardia: development of an algorithm to predict the anatomic site of origin. J Am Coll Cardiol. 2006;48:1010–7.

    Article  PubMed  Google Scholar 

  7. Olgin JE, Kalman JM, Fitzpatrick AP, Lesh MD. Role of right atrial endocardial structures as barriers to conduction during human type I atrial flutter. Activation and entrainment mapping guided by intracardiac echocardiography. Circulation. 1995;92:1839–48.

    Article  CAS  PubMed  Google Scholar 

  8. Papez JW. Heart musculature of the atria. Am J Anat. 1920;27:255–85.

    Article  Google Scholar 

  9. Ho SY, Anderson RH, Sanchez-Quintana D. Atrial structure and fibres: morphologic bases of atrial conduction. Cardiovasc Res. 2002;54:325–36.

    Article  CAS  PubMed  Google Scholar 

  10. Higuchi K, Yamauchi Y, Hirao K, et al. Superior vena cava as initiator of atrial fibrillation: factors related to its arrhythmogenicity. Heart Rhythm. 2010;(7):1186–91. https://doi.org/10.1016/j.hrthm.2010.05.017.

  11. Bachmann G. The inter-auricular time interval. Am J Phys. 1916;41:309–20.

    Google Scholar 

  12. Markides V, Schilling RJ, Ho SY, et al. Characterization of left atrial activation in the intact human heart. Circulation. 2003;107:733–9.

    Article  PubMed  Google Scholar 

  13. Makino M, Inoue S, Matsuyama TA, et al. Diverse myocardial extension and autonomic innervation on ligament of Marshall in humans. J Cardiovasc Electrophysiol. 2006;17:594–9.

    Article  PubMed  Google Scholar 

  14. Haïssaguerre M, Jais P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339:659–66.

    Article  PubMed  Google Scholar 

  15. Nathan H, Eliakim M. The junction between the left atrium and the pulmonary veins. An anatomic study of human hearts. Circulation. 1966;34:412–22.

    Article  CAS  PubMed  Google Scholar 

  16. Saito T, Waki K, Becker AE. Left atrial myocardial extension onto pulmonary veins in humans: anatomic observations relevant for atrial arrhythmias. J Cardiovasc Electrophysiol. 2000;11:888–94.

    Article  CAS  PubMed  Google Scholar 

  17. Ogawa G, Inoue S, Matsuyama TA, et al. Histological study of left atrial wall – a consideration of the compound myocardial architecture and potential durability with respect to catheter ablation in pulmonary vein isolation procedure. Showa University Journal of. Med Sci. 2010;22:211–9.

    Google Scholar 

  18. Inoue S, Becker AE. Posterior extensions of the human compact atrioventricular node: a neglected anatomic feature of potential clinical significance. Circulation. 1998;97:188–93. Erratum in: Circulation 1998;97:1216

    Article  CAS  PubMed  Google Scholar 

  19. Inoue S, Becker AE, Riccardi R, Gaita F. Interruption of the inferior extension of the compact atrioventricular node underlies successful radio frequency ablation of atrioventricular nodal reentrant tachycardia. J Interv Card Electrophysiol. 1999;3:273–7.

    Article  CAS  PubMed  Google Scholar 

  20. Kaneko Y, Naito S, Okishige K, et al. Atypical fast-slow atrioventricular nodal reentrant tachycardia incorporating a “superior” slow pathway: a distinct supraventricular tachyarrhythmia. Circulation. 2016;133:114–23. https://doi.org/10.1161/ciculationaha.115.018443.

    Article  PubMed  Google Scholar 

  21. McGuire MA, de Bakker JM, et al. Atrioventricular junctional tissue. Discrepancy between histological and electrophysiological characteristics. Circulation. 1996;94:571–7.

    Google Scholar 

  22. Inoue S, Becker AE. Koch's triangle sized up: anatomical landmarks in perspective of catheter ablation procedures. Pacing Clin Electrophysiol. 1998;21(8):1553.

    Article  CAS  PubMed  Google Scholar 

  23. Anderson RH, Boyett MR, Dobrzynski H, Moorman AFM. The anatomy of the conduction system: implications for the clinical cardiologist. J Cardiovasc Trans Res. 2013;6:187–96. https://doi.org/10.1007/s12265-012-9433-0.

    Article  Google Scholar 

  24. Fitzpatrick AP, Gonzales RP, Lesh MD, et al. New algorithm for the localization of accessory atrioventricular connections using a baseline electrocardiogram. J Am Coll Cardiol. 1994;23:107–16.

    Google Scholar 

  25. Matsuyama TA, Inoue S, Tanno K, et al. Ectopic nodal structures in a patient with atrial tachycardia originating from the mitral valve annulus. Europace. 2006;8:977–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of General Medicine, Department of Perioperative Medicine, Showa University Dental Hospital Medical Clinic, Showa University School of Dentistry, 2-1-1 Kitasenzoku, Ota-ku, Tokyo, 145-8515, Japan

    Shin Inoue & Genyo Ogawa

  2. Department of Legal Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan

    Taka-Aki Matsuyama

Authors
  1. Shin Inoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Genyo Ogawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Taka-Aki Matsuyama
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shin Inoue .

Editor information

Editors and Affiliations

  1. Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan

    Kenzo Hirao

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer Nature Singapore Pte Ltd.

About this chapter

Cite this chapter

Inoue, S., Ogawa, G., Matsuyama, TA. (2018). Atrial and Atrioventricular Junctional Anatomy: Myocardial Orientation and Its Heterogeneity. In: Hirao, K. (eds) Catheter Ablation. Springer, Singapore. https://doi.org/10.1007/978-981-10-4463-2_1

Download citation

  • DOI: https://doi.org/10.1007/978-981-10-4463-2_1

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-10-4462-5

  • Online ISBN: 978-981-10-4463-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation