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Review

The Anatomy of the Atrioventricular Node

by
Robert H. Anderson
1,*,
Damián Sánchez-Quintana
2,
Jorge Nevado-Medina
2,
Diane E. Spicer
3,
Justin T. Tretter
4,
Wouter H. Lamers
5,
Zihan Hu
5,
Andrew C. Cook
6,
Eduardo Back Sternick
7 and
Demosthenes G. Katritsis
8,9
1
Biosciences Division, Newcastle University, Newcastle-upon-Tyne NE2 4HH, UK
2
Department of Human Anatomy and Cell Biology, Faculty of Medicine, University of Extremadura, 06006 Badajoz, Spain
3
Heart Institute, Johns Hopkins All Children’s Hospital, St. Petersburg, FL 33701, USA
4
Division of Pediatric Cardiology, Cleveland Clinic Children’s, and The Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
5
Department of Anatomy & Embryology, Maastricht University, 6211 LK Maastricht, The Netherlands
6
Institute of Cardiovascular Science, University College, London WC1E 6BT, UK
7
Electrophysiology Unit, Biocor Instituto, Nova Lima 34006083, Brazil
8
Department of Cardiology, Hygeia Hospital, 15123 Athens, Greece
9
Johns Hopkins Hospital, Baltimore, MD 21287, USA
*
Author to whom correspondence should be addressed.
J. Cardiovasc. Dev. Dis. 2025, 12(7), 245; https://doi.org/10.3390/jcdd12070245
Submission received: 8 June 2025 / Revised: 18 June 2025 / Accepted: 20 June 2025 / Published: 26 June 2025
(This article belongs to the Special Issue Updates on Atrio-Ventricular Node Anatomy and Physiology and on AVNRTs Circuit)
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Abstract

The anatomical arrangement of the atrioventricular node has been likened to a riddle wrapped up in an enigma. There are several reasons for this alleged mystery, not least the marked variability in structure between different species. Lack of detailed knowledge of the location of the node relative to the atrial and ventricular septal structures has also contributed to previous misunderstandings. Recent studies comparing the findings of gross dissection with virtual dissection of living datasets, combined with access to a large number of serially sectioned human and animal hearts, have served to provide the evidence to solve the riddle. We summarise these findings in this review. We explain how the node is located within the atrial walls of the inferior pyramidal space. It becomes the non-branching component of the atrioventricular conduction axis as the axis extends through the plane of atrioventricular insulation to enter the infero-septal recess of the left ventricular outflow tract. The node itself is formed by contributions from the tricuspid and mitral vestibules, with extensive additional inputs from the base of the atrial septum. We show how knowledge of development enhances the appreciation of the arrangements and offers an explanation as to why, on occasion, there can be persisting nodoventricular connections. We discuss the findings relative to the circuits producing atrioventricular re-entry tachycardia. We conclude by emphasising the significance of the variation of the anatomical arrangements within different mammalian species.
Keywords: compact node; inferior extensions; fast pathway; slow pathway; inferior pyramidal space; infero-septal recess compact node; inferior extensions; fast pathway; slow pathway; inferior pyramidal space; infero-septal recess

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MDPI and ACS Style

Anderson, R.H.; Sánchez-Quintana, D.; Nevado-Medina, J.; Spicer, D.E.; Tretter, J.T.; Lamers, W.H.; Hu, Z.; Cook, A.C.; Sternick, E.B.; Katritsis, D.G. The Anatomy of the Atrioventricular Node. J. Cardiovasc. Dev. Dis. 2025, 12, 245. https://doi.org/10.3390/jcdd12070245

AMA Style

Anderson RH, Sánchez-Quintana D, Nevado-Medina J, Spicer DE, Tretter JT, Lamers WH, Hu Z, Cook AC, Sternick EB, Katritsis DG. The Anatomy of the Atrioventricular Node. Journal of Cardiovascular Development and Disease. 2025; 12(7):245. https://doi.org/10.3390/jcdd12070245

Chicago/Turabian Style

Anderson, Robert H., Damián Sánchez-Quintana, Jorge Nevado-Medina, Diane E. Spicer, Justin T. Tretter, Wouter H. Lamers, Zihan Hu, Andrew C. Cook, Eduardo Back Sternick, and Demosthenes G. Katritsis. 2025. "The Anatomy of the Atrioventricular Node" Journal of Cardiovascular Development and Disease 12, no. 7: 245. https://doi.org/10.3390/jcdd12070245

APA Style

Anderson, R. H., Sánchez-Quintana, D., Nevado-Medina, J., Spicer, D. E., Tretter, J. T., Lamers, W. H., Hu, Z., Cook, A. C., Sternick, E. B., & Katritsis, D. G. (2025). The Anatomy of the Atrioventricular Node. Journal of Cardiovascular Development and Disease, 12(7), 245. https://doi.org/10.3390/jcdd12070245

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