Cardiac Conduction

Unlike skeletal muscle fibers (cells), which are independent of one another, cardiac muscle fibers (contractile muscle fibers) are linked by intercalated discs, areas where the plasma membranes intermesh. Within the intercalated discs, the adjacent cells are structurally connected by desmosomes, tight seals that weld the plasma membranes together, and electrically connected by gap junctions, ionic channels that allow the transmission of a depolarization event. As a result, the entire myocardium functions as a single unit with a single contraction of the atria followed by a single contraction of the ventricles.

Action potentials (electrical impulses) in the heart originate in specialized cardiac muscle cells, called autorhythmic cells. These cells are self‐excitable, able to generate an action potential without external stimulation by nerve cells. The autorhythmic cells serve as a pacemaker to initiate the cardiac cycle (pumping cycle of the heart) and provide a conduction system to coordinate the contraction of muscle cells throughout the heart. The autorhythmic cells are concentrated in the following areas:

  • The sinoatrial (SA) node, located in the upper wall of the right atrium, initiates the cardiac cycle by generating an action potential that spreads through both atria through the gap junctions of the cardiac muscle fibers.
  • The atrioventricular (AV) node, located near the lower region of the interatrial septum, receives the action potential generated by the SA node. A slight delay of the electrical transmission occurs here, allowing the atria to fully contract before the action potential is passed on to the ventricles.
  • The atrioventricular (AV) bundle (bundle of His) receives the action potential from the AV node and transmits the impulse to the ventricles by way of the right and left bundle branches. Except for the AV bundle, which provides the only electrical connection, the atria are electrically insulated from the ventricles.
  • The Purkinje fibers are large‐diameter fibers that conduct the action potential from the interventricular septum, down to the apex, and then upward through the ventricles.