The internodal atrial myocardium

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Abstract
The anatomical substrates of internodal conduction have long been a contentious topic. Debated first by the German Pathological Society in 1910, the consensus of established opinion for over half a century was that conduction between sinus and atrioventricular nodes occurred through plain myocardium. This was a conclusion supported by Truex in 1961. Despite his restatement of this fact in 1976, it has become fashionable to describe internodal conduction as being mediated by specialized internodal pathways. To reinvestigate this problem we studied 22 human fetal and 32 human infant hearts. In each case it was possible to cut the atrial tissues as a single block of tissue and to examine serial sections through the internodal myocardium. The sinus node, atrioventricular node, and segments of atrioventricular ring specialized tissue were recognized as specialized tissue using the light microscope in each heart. In contrast, there was nothing “special” about the myocardium between the nodes, nor was it possible to recognize tracts on the basis of either histological appearance or cellular architecture. It is concluded that, from the standpoint of light microscopy, there is no evidence whatsoever to support the purported concept of specialized anatomical substrates for internodal conduction.