Revisiting heart activation-conduction physiology, part I: atria. 2014

Gerard M Guiraudon, and Douglas L Jones
Canadian Surgical Technologies and Advance Robotics, Lawson Health Research Institute, London Health Science Center, London, Ontario, Canada, gguiraud@uwo.ca.

This discussion paper re-examines the conduction-activation of the atria, based on observations, with respect to the complexity of the heart as an organ with a brain, and its evolution from a peristaltic tube. The atria do not require a specialized conduction system because they use the subendocardial layer to produce centripetal transmural activation fronts, regardless of the anatomical and histological organization of the transmural atrial wall. This has been described as "two-layer" physiology which provides robust transmission of activation from the sinus to the AV node via a centripetal transmural activation front. New productive insights can come from re-examining the physiology, not only during sinus rhythm but also during atrial tachycardias, in particular atrial flutter and atrial fibrillation (AF). During common flutter, the areas of slow conduction, in the isthmus and following trabeculations, particularly the subendocardial layer confines conduction through the trabeculations which supports re-entry. During experimental or postoperative flutter, the circular 2D activation around the obstacle follows the physiological transmural activation. Understanding this physiology offers insights into AF. During acute or protracted AF, the presence of stationary or drifting rotors is characteristic and consistent with normal physiological 2D atrial activation, suggesting that suppressing physiological transmural activation of AF will permanently restore normal sinus node atrial activation. In contrast, during permanent AF, normal 2D activation is abolished; the presence of transmural, serpentine, and chaotic atrial activation suggests that the normal physiological activation pattern has been replaced by a new, irreversible variety of atrial conduction that is a new physiology, which is consistent with evolution of complex systems.

UI MeSH Term Description Entries
D009200 Myocardial Contraction Contractile activity of the MYOCARDIUM. Heart Contractility,Inotropism, Cardiac,Cardiac Inotropism,Cardiac Inotropisms,Contractilities, Heart,Contractility, Heart,Contraction, Myocardial,Contractions, Myocardial,Heart Contractilities,Inotropisms, Cardiac,Myocardial Contractions
D011690 Purkinje Fibers Modified cardiac muscle fibers composing the terminal portion of the heart conduction system. Purkinje Fiber,Fiber, Purkinje,Fibers, Purkinje
D004699 Endocardium The innermost layer of the heart, comprised of endothelial cells. Endocardiums
D006321 Heart The hollow, muscular organ that maintains the circulation of the blood. Hearts
D006329 Heart Conduction System An impulse-conducting system composed of modified cardiac muscle, having the power of spontaneous rhythmicity and conduction more highly developed than the rest of the heart. Conduction System, Heart,Conduction Systems, Heart,Heart Conduction Systems,System, Heart Conduction,Systems, Heart Conduction
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001281 Atrial Fibrillation Abnormal cardiac rhythm that is characterized by rapid, uncoordinated firing of electrical impulses in the upper chambers of the heart (HEART ATRIA). In such case, blood cannot be effectively pumped into the lower chambers of the heart (HEART VENTRICLES). It is caused by abnormal impulse generation. Auricular Fibrillation,Familial Atrial Fibrillation,Paroxysmal Atrial Fibrillation,Persistent Atrial Fibrillation,Atrial Fibrillation, Familial,Atrial Fibrillation, Paroxysmal,Atrial Fibrillation, Persistent,Atrial Fibrillations,Atrial Fibrillations, Familial,Atrial Fibrillations, Paroxysmal,Atrial Fibrillations, Persistent,Auricular Fibrillations,Familial Atrial Fibrillations,Fibrillation, Atrial,Fibrillation, Auricular,Fibrillation, Familial Atrial,Fibrillation, Paroxysmal Atrial,Fibrillation, Persistent Atrial,Fibrillations, Atrial,Fibrillations, Auricular,Fibrillations, Familial Atrial,Fibrillations, Paroxysmal Atrial,Fibrillations, Persistent Atrial,Paroxysmal Atrial Fibrillations,Persistent Atrial Fibrillations
D016275 Atrial Function The hemodynamic and electrophysiological action of the HEART ATRIA. Atrial Functions,Function, Atrial,Functions, Atrial
D016279 Atrial Function, Left The hemodynamic and electrophysiological action of the LEFT ATRIUM. Left Atrial Function,Atrial Functions, Left,Function, Left Atrial,Functions, Left Atrial,Left Atrial Functions
D016280 Atrial Function, Right The hemodynamic and electrophysiological action of the RIGHT ATRIUM. Right Atrial Function,Atrial Functions, Right,Function, Right Atrial,Functions, Right Atrial,Right Atrial Functions

Related Publications

Gerard M Guiraudon, and Douglas L Jones
January 1984, Critical care nurse,
Gerard M Guiraudon, and Douglas L Jones
January 2002, Clinical journal of oncology nursing,
Gerard M Guiraudon, and Douglas L Jones
January 1985, The Annals of physiological anthropology = Seiri Jinruigaku Kenkyukai kaishi,
Gerard M Guiraudon, and Douglas L Jones
October 1971, The American journal of cardiology,
Gerard M Guiraudon, and Douglas L Jones
September 2001, Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine,
Gerard M Guiraudon, and Douglas L Jones
July 2016, Cephalalgia : an international journal of headache,
Gerard M Guiraudon, and Douglas L Jones
May 1967, Japanese heart journal,
Gerard M Guiraudon, and Douglas L Jones
September 1972, Circulation,
Gerard M Guiraudon, and Douglas L Jones
February 1980, AANA journal,
Gerard M Guiraudon, and Douglas L Jones
January 1999, Nursing times,
Copied contents to your clipboard!