Institute of Biosciences, Newcastle University, Newcastle upon Tyne, United Kingdom.
Department of Anatomy and Cell Biology, Universidad de Extremadura, Badajoz, Spain.
Heart Rhythm. 2022 Oct;19(10):1738-1746. doi: 10.1016/j.hrthm.2022.05.032. Epub 2022 May 31.
More than a century has passed since Tawara demonstrated the presence of the insulated pathways that extend from the "knoten" at the base of the atrial septum to their ramifications at the ventricular apexes. Having initially doubted the existence of the atrioventricular bundle until reading the monograph produced by Tawara, Keith, together with Flack, soon revealed the presence of the sinus node. Shortly thereafter, Thorel suggested that a special system might be found within the atrial walls, connecting the newly discovered atrial nodes. This prompted the convening of a special session of the German Pathological Society in 1910. The consensus was that no tracts existed within the atrial walls, with Aschoff and Mönckeberg establishing criteria to be met by those proposing recognition of "specialized" atrial conducting pathways. None of those who subsequently proposed the presence of such pathways have discussed their findings on the basis of the criteria established at the meeting of 1910. It remains the case, nonetheless, that drawings continue to be offered by cardiological experts showing narrow pathways within the atrial walls that parallel the arrangement used to show the ventricular conduction pathways. A similar drawing adorns the front cover of Heart Rhythm Journal. We are unaware of any evidence supporting the presence of pathways as illustrated existing within the overall walls of the atrial chambers. In this review, we summarize the evidence that shows, instead, that it is the aggregation of the working atrial cardiomyocytes within the atrial walls that underscores preferential anisotropic interatrial conduction.
自 Tawara 证明从房间隔底部的“结”延伸到心室顶点的绝缘途径存在以来，已经过去了一个多世纪。Keith 和 Flack 在阅读了 Tawara 的专着后，最初怀疑房室束的存在，很快就揭示了窦房结的存在。此后不久，Thorel 提出可能在心房壁内发现一个特殊系统，连接新发现的心房节点。这促使德国病理学会于 1910 年召开了一次特别会议。会议的共识是，心房壁内不存在束，Aschoff 和 Mönckeberg 确立了那些提出承认“专门”心房传导途径的人必须满足的标准。此后，没有一个人根据 1910 年会议确立的标准讨论过他们的发现。然而，仍然有心血管专家提供的绘图显示，心房壁内存在与心室传导途径排列平行的狭窄途径。类似的绘图装饰着《心律杂志》的封面。我们不知道有任何证据支持存在如图所示的心房腔整体壁内的途径。在这篇综述中，我们总结了证据，表明正是心房壁内工作的心房心肌细胞的聚集强调了优先各向异性的房间隔传导。
