Recognition of the anatomical structure of the atrioventricular node:
Connection between the retroaortic node and the compact node
Abstract
Introduction: The complex electrophysiological phenomena related to the
atrioventricular node (AVN) are due to its complex anatomical
structures. Aside from the inferior nodal extension (INE), other
node-like tissues, such as the retroaortic node (RN), have been less
described and may also share the mechanism of normal conduction and
abnormal conduction in AVN re-entrant tachycardia (AVNRT). Methods:
High-density sections of the entire AVN were obtained from rats and
rabbits. Fibrosis was analyzed by Masson’s trichrome staining. Connexin
(Cx43, Cx40, and Cx45) and ion channel (Nav1.5, Cav3.1, and HCN4)
proteins were immunohistochemically labeled for the analysis of tissue
features. Three-dimensional (3D) reconstruction of the AV junction was
performed to clarify the relationships among different structures.
Results: The RN expressed the same connexin isoforms as the compact node
(CN) and INE. Nav1.5 labeling was present at a low level in the CN, RN
and INE, where Cav3.1 and HCN4 were expressed. The CN connected with the
RN in a narrow strip pattern at the level of the start of the CN. The RN
presented as a shuttle shape and was the only tissue directly connected
with the atrium in the anterior septum. Conclusion: The RN connects with
the AVN anatomically, suggesting that there is direct electrical
conduction between them. The entrance of the atria into the AVN is the
distal part of the RN, which may form the fast pathway of the AVN.