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Recognition of the anatomical structure of the atrioventricular node: Connection between the retroaortic node and the compact node
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  • Fan Wang,
  • Lulu Zhang,
  • Wei Meng,
  • Bin Zhu,
  • Shufeng Li,
  • Qiuwen Wu,
  • shuo zhang
Fan Wang
Second Affiliated Hospital of Harbin Medical University
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Lulu Zhang
Second Affiliated Hospital of Harbin Medical University
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Wei Meng
Second Affiliated Hospital of Harbin Medical University
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Bin Zhu
Second Affiliated Hospital of Harbin Medical University
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Shufeng Li
Second Affiliated Hospital of Harbin Medical University
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Qiuwen Wu
Harbin Medical University Second Affiliated Hospital Department of Cardiology
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shuo zhang
Second Affiliated Hospital of Harbin Medical University
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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.

Peer review status:ACCEPTED

10 Dec 2020Submitted to Journal of Cardiovascular Electrophysiology
14 Dec 2020Submission Checks Completed
14 Dec 2020Assigned to Editor
16 Dec 2020Reviewer(s) Assigned
02 Jan 2021Review(s) Completed, Editorial Evaluation Pending
04 Jan 2021Editorial Decision: Revise Minor
31 Mar 20211st Revision Received
10 Apr 2021Submission Checks Completed
10 Apr 2021Assigned to Editor
10 Apr 2021Reviewer(s) Assigned
11 Apr 2021Review(s) Completed, Editorial Evaluation Pending
12 Apr 2021Editorial Decision: Accept