From the Department of Cardiovascular Pathology, Academic Medical Center,
University of Amsterdam, The Netherlands.
Correspondence to Anton E. Becker, MD, Department of Cardiovascular Pathology, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, Netherlands.
Background—Catheter ablation
procedures have revived interest in the detailed anatomy of the
specialized atrioventricular (AV) septal junctional
area. The compact AV node usually is considered to have a blunt
posterior end. The objective of this study was to reconstruct the human
compact AV node in relation to the landmarks of Koch's triangle, with
emphasis on its posterior extension.
Methods and Results—In 21 hearts obtained from autopsies, the AV
nodal septal junctional area was removed en bloc, serially sectioned,
and reconstructed. None of the hearts showed a blunt posterior ending
of the compact AV node; 13 showed posterior extensions on both the
right and left sides; 7 had a rightward posterior extension only; and 1
heart showed a single leftward extension. Hence, a rightward posterior
extension was present in 20 of 21 hearts. Furthermore, in 16 of
these 20 hearts, the rightward extension continued to the level of the
coronary sinus ostium; in 7, the bundle extended beyond this
anatomic landmark. The mean length of the right posterior extension was
4.4±2.0 mm; that of the leftward posterior extension was
1.8±0.9 mm. Superimposed onto the slope of the muscular AV
septum, viewed from the right atrium, the rightward extension ran close
to the tricuspid annulus with the leftward extension positioned
superiorly.
Conclusions—The human compact AV node contains rightward and
leftward posterior extensions, with the right extension close to the
tricuspid annulus. It is tempting to speculate that these extensions
are involved in "slow pathway" conduction.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Posterior Extensions of the Human Compact Atrioventricular Node
A Neglected Anatomic Feature of Potential Clinical Significance
Key Words: atrioventricular node • arrhythmia • electrophysiology • reentry • tachycardia • ablation
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