Abstract
Purpose
The aim of this study is to review the key features of anatomy of the sinus node of the human sinus node and its pathological variations as reported in the literature and supplemented with our observations.
Results
The sinus node is located adjacent to important structures such as the right phrenic nerve and the nodal artery. Although intimately related to its matrix of fibrous tissue, the nodal cells are in contact with atrial myocardium through nodal extensions. Nodal cell numbers decrease with age as part of the normal aging process. Pathological changes include diminished size of node and nodal cell replacement with fibro-fatty tissues.
Conclusions
The location of the normal sinus node is well recognised. There is variation in the relationship of the node and its arterial supply to the terminal crest and the cavo-atrial junction.
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References
Hudson, R. E. B. (1960). The human pacemaker and its pathology. British Heart Journal, 22, 153–167.
Wenkebach, K. F. (1907). Beitrage zur Kenntnis der menschlichen Herzatigkeit. Archiv fur Anatomie und Physiologie, 2, 1–24.
Keith, A., & Flack, M. (1907). The form and nature of the muscular connections between the primary divisions of the vertebrate heart. Journal of Anatomy and Physiology, 41, 172–189.
Sanchez-Quintana, D., Cabrera, C., Farre, J., Climent, V., Anderson, R. H., & Ho, S. Y. (2005). Sinus node revisited in the era of electroanatomical mapping and catheter ablation. Heart, 91, 189–194.
Matsuyama, T.-A., Inuoe, S., Kobayashi, Y., Sakai, T., Saito, T., Katagiri, T., & Ota, H. (2004). Anatomical diversity and age related histological changes in the human right atrial posterior wall. Europace, 6, 307–315.
Ho, S. Y. (1994). Morphologic aspects of sinus node dysfunction, congenital and surgical atrioventricular block, bundle branch and fascicular blocks. Progress in Pediatric Cardiology, 3, 203–225.
Chiu, I., Hung, C. R., How, S. W., & Chen, M. R. (1989). Is the sinus node visible grossly? A histological study of normal hearts. International Journal of Cardiology, 22, 83–87.
Chandler, N., Aslanidi, O., Buckley, D., Inada, S., Birchall, S., Atkinson, A., Kirk, D., Monfredi, O., Molenaar, P., Anderson, R., Sharma, V., Sigg, D., Zhang, H., Boyett, M., & Dobrzynski, H. (2011). Computer three-dimensional anatomical reconstruction of the human sinus node and a novel paranodal area. Anatomical Record, 294, 970–979.
Sanchez-Quintana, Cabrera, J. A., Climent, V., Farre, J., Weiglein, A., & Ho, S. Y. (2005). How close are the phrenic nerves to cardiac structures? Implications for cardiac interventionalists. Journal of Cardiovascular Electrophysiology, 16, 309–313.
Anderson, K. R., Ho, S. Y., & Anderson, R. H. (1979). Location and vascular supply of sinus node in human heart. British Heart Journal, 41, 28–32.
Busquet, J., Fontan, F., Anderson, R. H., Ho, S. Y., & Davies, M. J. (1984). The surgical significance of the atrial branches of the coronary arteries. International Journal of Cardiology, 6, 223–234.
Becker, A. E. (1978). General comments. In F. I. M. Bonke (Ed.), The sinus node—structure, function and clinical relevance (p. 219). The Hague: Martinus Nijhoff.
Lev, M. (1954). Ageing changes in sino-atrial node. Journal of Gerontology, 9, 1–9.
Davies, M. J., & Pomerance, A. (1972). Quantitative study of ageing changes in the human S-A node and intermodal tracts. British Heart Journal, 34, 150–152.
Sims, B. A. (1972). Pathogenesis of arrhythmias. British Heart Journal, 34, 336–340.
Thery, C., Gosselin, B., Lekieffre, J., & Warembourg, H. (1977). Pathology of sinoatrial node. Correlations with electrocardiographic findings in 111 patients. American Heart Journal, 93, 735–740.
Shiraishi, I., Takamatsu, T., Minamikawa, T., Onouchi, Z., & Fujita, S. (1992). Quantitative histological analysis of the human sinoatrial node during growth and aging. Circulation, 85, 2176–2184.
Ailings, A. M., Abbas, R. F., & Bouman, L. N. (1995). Age-related changes in structure and relative collagen content of the human and feline sinoatrial node. European Heart Journal, 16, 1655–1657.
Csepe, T. A., Kalyanasundaram, A., Hansen, B. J., Zhao, J., & Fedorov, V. V. (2015). Fibrosis: a structural modulator of sinoatrial node physiology and dysfunction. Frontiers in Physiology, 6, 37.
Ih, S., & Saitoh, S. (1982). The histological substratum for atrial fibrillation in man. Acta Pathologica Japonica, 32, 183–191.
Hurlè, A., Climent, V., & Sánchez-Quintana, D. (2006). Sinus node structural changes in patients with long-standing chronic atrial fibrillation. The Journal of Thoracic and Cardiovascular Surgery, 131, 1394–1395.
Hurle, A., Sanchez-Quintana, D., Ho, S. Y., Bernabeu, E., Murillo, M., & Climent, V. (2010). Capillary supply to the sinus node in subjects with long-term atrial fibrillation. The Annals of Thoracic Surgery, 89, 38–43.
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Ho, S.Y., Sánchez-Quintana, D. Anatomy and pathology of the sinus node. J Interv Card Electrophysiol 46, 3–8 (2016). https://doi.org/10.1007/s10840-015-0049-6
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DOI: https://doi.org/10.1007/s10840-015-0049-6