russjcardiolРоссийский кардиологический журналRussian Journal of Cardiology1560-40712618-7620«SILICEA-POLIGRAF» LLC10.15829/1560-4071-2024-6191KUNMPIrussjcardiol-6191Research ArticleДИССИНХРОНИЯ. РЕСИНХРОНИЗАЦИЯ. СТИМУЛЯЦИЯ. ХРОНИЧЕСКАЯ СЕРДЕЧНАЯ НЕДОСТАТОЧНОСТЬDISSYNCHRONY. RESYNCHRONIZATION. STIMULATION. CHRONIC HEART FAILUREАнатомия, гистология и электронная микроскопия проводящей системы сердца. Современное представление и новые сведения: обзорAnatomy, histology, and electron microscopy of the cardiac conduction system. Current views and new data: reviewhttps://orcid.org/0000-0003-0735-7822МитрофановаЛ. Б.MitrofanovaL. B.

Митрофанова Любовь Борисовна — д. м. н., профессор, зав. кафедрой патологической анатомии с клиникой, г. н. с. научно-исследовательской лаборатории патоморфологии.

Санкт-Петербург

St. Petersburg

lubamitr@yandex.ruФГБУ Национальный медицинский исследовательский центр им. В.А. Алмазова Минздрава РоссииРоссияAlmazov National Medical Research CenterRussian Federation202413122024294SОбразование61916191Copyright © Митрофанова Л.Б., 20252025Митрофанова Л.Б.Mitrofanova L.B.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://russjcardiol.elpub.ru/jour/article/view/6191

В литературном обзоре дано современное представление об анатомии, гистологии, иммуногистохимии, электронной микроскопии и электронной иммуноцитохимии проводящей системы сердца (ПСС) на основании литературных данных и собственных исследований автора на протяжении более 30 лет. Описаны новая специализированная х-структура ПСС, открытая автором и опубликованная в 2014г, и еще один тип клеток, входящих в состав синусного и атриовентрикулярных узлов — телоцитов, способных генерировать и проводить электрический импульс. На основании послойного препарирования и серийных гистологических срезов, выполненных на более 400 сердцах взрослых людей, дана топографическая анатомия мышечного каркаса предсердий. В статье также описана иннервация предсердий.

The review provides a current view of the anatomy, histology, immunohistochemistry, electron microscopy, and electron immunocytochemistry of the cardiac conduction system (CCS) based on literature data and the author's own research over more than 30 years. The article describes a new specialized x-structure of the CCS, discovered by the author and published in 2014, and another type of cells that are part of the sinus and atrioventricular nodes — telocytes, capable of generating and conducting an electrical impulse. Based on layer-by-layer dissection and serial histological sections performed on more than 400 adult hearts, the topographic anatomy of the atrial muscular framework is given. The article also describes the atrial innervation.

специализированные клетки проводящей системы сердцаинтерстициальные пейсмейкерых-структураанатомия мышечных пучков предсердий и межпредсердной перегородкиspecialized cells of the cardiac conduction systeminterstitial pacemakersx-structureanatomy of the atrial muscle bundles and interatrial septumReferencesМихайлов С. С. Клиническая анатомия сердца. М: Медицина, 1987. с. 288.Mikhailov SS. Clinical anatomy of the heart. M.: Medicine, 1987. p. 288 (In Russ.)Синев А. Ф., Крымский Л. Д. Хирургическая анатомия проводящей системы сердца. М: Медицина, 1985. с. 272.Sinev AF, Krymsky LD. Surgical anatomy of the cardiac conduction system. M.: Medicine, 1985. p. 272. (In Russ.)Aschoff L. Referat über die Herzstörungen in ihren Beziehungen zu den Spezifischen Muskel system des Herzens. Verh Dtsch Pathol Ges. 1910;14:3-35.Aschoff L. Referat über die Herzstörungen in ihren Beziehungen zu den Spezifischen Muskel system des Herzens. Verh Dtsch Pathol Ges. 1910;14:3-35.Mönckeberg JG. Beitrage zur normalen und pathologischen Anatomie des Herzens. Verh Dtsch Pathol Ges. 1910;14:64-71.Mönckeberg JG. Beitrage zur normalen und pathologischen Anatomie des Herzens. Verh Dtsch Pathol Ges. 1910;14:64-71.Anderson RH, Christoffels VM, Moorman AFM. Controversies concerning the anatomical definition of the conduction tissues. Anat Rec. 2004;280B:8-14.Anderson RH, Christoffels VM, Moorman AFM. Controversies concerning the anatomical definition of the conduction tissues. Anat Rec. 2004;280B:8-14.James TN. The connecting pathways between the sinus node and A-V node and between the right and left atrium in the human heart. Am. Heart J. 1963;66:498-508.James TN. The connecting pathways between the sinus node and A-V node and between the right and left atrium in the human heart. Am. Heart J. 1963;66:498-508.James TN. The internodal pathways of the human heart. Prog. Cardiovasc. Dis. 2001; 43:495-535. doi:10.1053/pcad.2001.24598.James TN. The internodal pathways of the human heart. Prog. Cardiovasc. Dis. 2001; 43:495-535. doi:10.1053/pcad.2001.24598.Sternick EB, Sánchez-Quintana D. Critical Assessment of the Concepts and Miscon­ceptions of the Cardiac Conduction System over the Last 100 Years: The Personal Quest of Robert H. Anderson. Journal of Cardiovascular Development and Disease. 2021;8(1):5. doi:10.3390/jcdd8010005.Sternick EB, Sánchez-Quintana D. Critical Assessment of the Concepts and Misconceptions of the Cardiac Conduction System over the Last 100 Years: The Personal Quest of Robert H. Anderson. Journal of Cardiovascular Development and Disease. 2021;8(1):5. doi:10.3390/jcdd8010005.Митрофанова Л. Б., Горшков А. Н., Коновалов П. В. и др. Телоциты в синоатриальном узле человека. Морфологические доказательства пейсмекерной активности клеток и возможности проводить электрический импульс. Российский кардиологический журнал. 2017;(9):42-9. doi:10.15829/1560-4071-2017-9-42-49.Mitrofanovа LB, Gorshkov AN, Konovalov PV, et al. Telocytes in the human sinoatrial node. Morphological evidence of pacemaker activity of cells and the ability to conduct an electrical impulse. Russian Journal of Cardiology. 2017;(9):42-9. (In Russ.) doi:10.15829/1560-4071-2017-9-42-49.Mitrofanova LB, Gorshkov AN, Konovalov PV, Krylova JS. Telocytes in the human sinoat­rial node. J Cell Mol Med. 2018;22(1):521-32. doi:10.1111/jcmm.13340.Mitrofanova LB, Gorshkov AN, Konovalov PV, Krylova JS. Telocytes in the human sinoat­rial node. J Cell Mol Med. 2018;22(1):521-32. doi:10.1111/jcmm.13340.Christoffels VM, Moorman AF. Development of the cardiac conduction system: why are some regions of the heart more arrhythmogenic than others? Circ Arrhythm Electrophysiol. 2009;2(2):195-207. doi:10.1161/CIRCEP.108.829341.Christoffels VM, Moorman AF. Development of the cardiac conduction system: why are some regions of the heart more arrhythmogenic than others? Circ Arrhythm Electro­physiol. 2009;2(2):195-207. doi:10.1161/CIRCEP.108.829341.Moskowitz IP, Kim JB, Moore ML, et al. A molecular pathway including id2, tbx5, and nkx2-5 required for cardiac conduction system development. Cell. 2007;129:1365-76. doi:10.1016/j.cell.2007.04.036.Moskowitz IP, Kim JB, Moore ML, et al. A molecular pathway including id2, tbx5, and nkx2-5 required for cardiac conduction system development. Cell. 2007;129:1365-76. doi:10.1016/j.cell.2007.04.036.Bakker ML, Boukens BJ, Mommersteeg MTM, et al. Transcription factor Tbx3 is required for the specification of the atrioventricular conduction system. Circ Res. 2008;102: 1340-9. doi:10.1161/CIRCRESAHA.107.169565.Bakker ML, Boukens BJ, Mommersteeg MTM, et al. Transcription factor Tbx3 is required for the specification of the atrioventricular conduction system. Circ Res. 2008;102: 1340-9. doi:10.1161/CIRCRESAHA.107.169565.Kurian T, Ambrosi C, Hucker W, et al. Anatomy and electrophysiology of the human AV node. Pacing Clin Electrophysiol. 2010;33(6):754-62. doi:10.1111/j.1540-8159.2010.02699.Kurian T, Ambrosi C, Hucker W, et al. Anatomy and electrophysiology of the human AV node. Pacing Clin Electrophysiol. 2010;33(6):754-62. doi:10.1111/j.1540-8159.2010.02699.Fedorov VV, Glukhov AV, Chang R, et al. Optical mapping of the isolated coronary-perfused human sinus node. J Am Coll Cardiol. 2010;56(17):1386-94. doi:10.1016/j.jacc.2010.03.098.Fedorov VV, Glukhov AV, Chang R, et al. Optical mapping of the isolated coronary-perfused human sinus node. J Am Coll Cardiol. 2010;56(17):1386-94. doi:10.1016/j.jacc.2010.03.098.Anderson RH, Ho SY, Becker A. The surgical anatomy of the conduction tissues. Thorax. 1983;38:408-20. doi:10.1136/thx.38.6.408.Anderson RH, Ho SY, Becker A. The surgical anatomy of the conduction tissues. Thorax. 1983;38:408-20. doi:10.1136/thx.38.6.408.Platonov PG, Mitrofanova LB, Orshanskaya V, Yen Ho S. Structural abnormalities in atrial walls are associated with presence and persistency of atrial fibrillation but not with age. J Am Coll Cardiol. 2011;58(21):2226-32. doi:10.1016/j.jacc.2011.05.061.Platonov PG, Mitrofanova LB, Orshanskaya V, Yen Ho S. Structural abnormalities in atrial walls are associated with presence and persistency of atrial fibrillation but not with age. J Am Coll Cardiol. 2011;58(21):2226-32. doi:10.1016/j.jacc.2011.05.061.Mitrofanova L, Ivanov V, Platonov PG. Anatomy of the inferior interatrial route in humans. Europace. 2005;7,Suppl2:49-55. doi:10.1016/j.eupc.2005.03.014.Mitrofanova L, Ivanov V, Platonov PG. Anatomy of the inferior interatrial route in humans. Europace. 2005;7,Suppl2:49-55. doi:10.1016/j.eupc.2005.03.014.Mitrofanova LB, Gorshkov AN, Lebedev DS, Mikhaylov EN. Evidence of specialized tissue in human interatrial septum: histological, immunohistochemical and ultrastructural findings. PLoS ONE. 2014;9(11):1-11. doi:10.1371/journal.pone.0113343.Mitrofanova LB, Gorshkov AN, Lebedev DS, Mikhaylov EN. Evidence of specialized tis­sue in human interatrial septum: histological, immunohistochemical and ultrastructural findings. PLoS ONE. 2014;9(11):1-11. doi:10.1371/journal.pone.0113343.Sizarov A, Devalla HD, Anderson RH, et al. Molecular Analysis of Patterning of Tissues in the Developing Human Heart Clinical Perspective. Circ Arrhythm Electrophysiol. 2011;4:532-42. doi:10.1161/CIRCEP.111.963421.Sizarov A, Devalla HD, Anderson RH, et al. Molecular Analysis of Patterning of Tissues in the Developing Human Heart Clinical Perspective. Circ Arrhythm Electrophysiol. 2011;4:532-42. doi:10.1161/CIRCEP.111.963421.Yanni J, Boyett MR, Anderson RH, et al. The extent of the specialized atrioventricular ring tissues. Heart Rhytm. 2009;6:672-80. doi:10.1016/j.hrthm.2009.01.021.Yanni J, Boyett MR, Anderson RH, et al. The extent of the specialized atrioventricular ring tissues. Heart Rhytm. 2009;6:672-80. doi:10.1016/j.hrthm.2009.01.021.Platonov PG, Ivanov V, Ho SY, Mitrofanova L. Left atrial posterior wall and without atrial fibrillation: data from 298 consecutive autopsies. J. Cardiovascular Electrophysiol. 2008;19(7):689-92. doi:10.1111/j.1540-8167.2008.01102.x.Platonov PG, Ivanov V, Ho SY, Mitrofanova L. Left atrial posterior wall and without atrial fibrillation: data from 298 consecutive autopsies. J. Cardiovascular Electrophysiol. 2008;19(7):689-92. doi:10.1111/j.1540-8167.2008.01102.x.Deaconu S, Deaconu A, Marascu G, et al. Arrhythmic Risk and Treatment after Transcatheter Atrial Septal Defect Closure. Diagnostics. 2024;14(1):33. doi:10.3390/diagnostics14010033.Deaconu S, Deaconu A, Marascu G, et al. Arrhythmic Risk and Treatment after Transcatheter Atrial Septal Defect Closure. Diagnostics. 2024;14(1):33. doi:10.3390/diagnostics14010033.Saito T, Waki K, Becker AE. Left atrial myocardial extension onto pulmonary veins in humans: anatomic observations relevant for atrial arrhythmias. J Cardiovasc Electrophysiol. 2000;11(8):888-94. doi:10.1111/j.1540-8167.2000.tb00068.x.Saito T, Waki K, Becker AE. Left atrial myocardial extension onto pulmonary veins in humans: anatomic observations relevant for atrial arrhythmias. J Cardiovasc Electrophysiol. 2000;11(8):888-94. doi:10.1111/j.1540-8167.2000.tb00068.x.Steiner I, Hájková P, Kvasnicka J, Kholová I. Myocardial sleeves of pulmonary veins and atrial fibrillation: a postmortem histopathological study of 100 subjects. Virchows Arch. 2006;449(1):88-95. doi:10.1007/s00428-006-0197-2.Steiner I, Hájková P, Kvasnicka J, Kholová I. Myocardial sleeves of pulmonary veins and atrial fibrillation: a postmortem histopathological study of 100 subjects. Virchows Arch. 2006;449(1):88-95. doi:10.1007/s00428-006-0197-2.Gupta T, Randhawa A, Sahni D. Histological evaluation of atrial muscle sleeve of pulmo­nary veins as relevant to trigger mapping and ablation. Surg Radiol Anat. 2020;42(11): 1271-7. doi:10.1007/s00276-020-02473-z.Gupta T, Randhawa A, Sahni D. Histological evaluation of atrial muscle sleeve of pulmo­nary veins as relevant to trigger mapping and ablation. Surg Radiol Anat. 2020;42(11): 1271-7. doi:10.1007/s00276-020-02473-z.Cavero I, Holzgrefe H. Internodal conduction pathways: revisiting a century-long debate on their existence, morphology, and location in the context of 2023 best science. Adv Physiol Educ. 2023;47(4):838-50. doi:10.1152/advan.00029.2023.Cavero I, Holzgrefe H. Internodal conduction pathways: revisiting a century-long debate on their existence, morphology, and location in the context of 2023 best science. Adv Physiol Educ. 2023;47(4):838-50. doi:10.1152/advan.00029.2023.Roney CH, Whitaker J, Sim I, et al. A technique for measuring anisotropy in atrial con­duction to estimate conduction velocity and atrial fibre direction. Comput Biol Med. 2019;104:278-90. doi:10.1016/j.compbiomed.2018.10.019.Roney CH, Whitaker J, Sim I, et al. A technique for measuring anisotropy in atrial con­duction to estimate conduction velocity and atrial fibre direction. Comput Biol Med. 2019;104:278-90. doi:10.1016/j.compbiomed.2018.10.019.Sheng YeX, Qu Y, Dan P, et al. Isolation and characterization of atrioventricular nodal cells from neonate rabbit heart. Circ Arrhythm Electrophysiol. 2011;4(6):936-46. doi:10.1161/CIRCEP.111.964056.Sheng YeX, Qu Y, Dan P, et al. Isolation and characterization of atrioventricular nodal cells from neonate rabbit heart. Circ Arrhythm Electrophysiol. 2011;4(6):936-46. doi:10.1161/CIRCEP.111.964056.Митрофанова Л. Б., Бобков Д. Е., Оганесян М. Г. и др. Исследование электрофизиологических свойств телоцитов атриовентрикулярного узла и перифокальной зоны синусного узла у человека и свиньи. Российский кардиологический журнал. 2020;25(12):3927. doi:10.15829/1560-4071-2020-3927.Mitrofanova LB, Bobkov DE, Oganesyan MG, et al. Study of electrophysiological properties of telocytes of the atrioventricular node and perifocal zone of the sinus node in humans and pigs. Russian Journal of Cardiology. 2020;25(12):3927. (In Russ.) doi:10.15829/1560-4071-2020-3927.Blackwell DJ, Faggioni M, Wleklinski MJ, et al. The Purkinje-myocardial junction is the anatomic origin of ventricular arrhythmia in CPVT. JCI Insight. 2022;7(3):e151893. doi:10.1172/jci.insight.151893.Blackwell DJ, Faggioni M, Wleklinski MJ, et al. The Purkinje-myocardial junction is the anatomic origin of ventricular arrhythmia in CPVT. JCI Insight. 2022;7(3):e151893. doi:10.1172/jci.insight.151893.Anderson RH, Ho SY, Becker AE. Anatomy of the human atrioventricular junctions revisited. Anat Rec. 2000;260(1):81-91. doi:10.1002/1097-0185(20000901)260:1<81:AID-AR90>3.0.CO;2-3.Anderson RH, Ho SY, Becker AE. Anatomy of the human atrioventricular junctions revi­sited. Anat Rec. 2000;260(1):81-91. doi:10.1002/1097-0185(20000901)260:1<81:AID-AR90>3.0.CO;2-3.Anderson RH, Becker AE, Tranum-Jensen J, Janse MJ. Anatomico-electrophysiological correlations in the conduction system-a review. Br Heart J. 1981;45:67-82. doi:10.1136/hrt.45.1.67.Anderson RH, Becker AE, Tranum-Jensen J, Janse MJ. Anatomico-electrophysiological correlations in the conduction system-a review. Br Heart J. 1981;45:67-82. doi:10.1136/hrt.45.1.67.Новиков И. И. Нервы и сосуды сердца. Минск: Наука и техника, 1975. с. 152.Novikov II. Nerves and vessels of the heart. Minsk: Science and Technology, 1975. p.152. (In Russ.)Митрофанова Л. Б., Пацюк А. В., Коновалов П. В. и др. Половые различия в ремоделировании предсердий и их интрамуральной иннервации при структурных заболеваниях сердца. Российский кардиологический журнал. 2017;(12):79-83. doi:10.15829/1560-4071-2017-12-79-83.Mitrofanova LB, Patsyuk AV, Konovalov PV, et al. Gender differences in atrial remodeling and their intramural innervation in structural heart diseases. Russian Journal of Cardiology. 2017;(12):79-83. (In Russ.) doi:10.15829/1560-4071-2017-12-79-83.

The authors declare that there are no conflicts of interest present.