Atrioventricular Conduction: Physiology and Autonomic Influences

Eric N Prystowsky; Jasen L Gilge

doi:10.1016/j.ccl.2023.03.015

Atrioventricular Conduction: Physiology and Autonomic Influences

Cardiol Clin. 2023 Aug;41(3):293-306. doi: 10.1016/j.ccl.2023.03.015.

Authors

Eric N Prystowsky¹, Jasen L Gilge²

Affiliations

¹ Cardiac Arrhythmia Service, St. Vincent Hospital, 8333 Naab Road, Indianapolis, IN 46260, USA; Duke University Medical Center, Durham, NC, USA. Electronic address: enprysto@ascension.org.
² St.Vincent Hospital, 8333 Naab Road, Indianapolis, IN 46260, USA.

PMID: 37321682
DOI: 10.1016/j.ccl.2023.03.015

Abstract

Atrioventricular (AV) nodal conduction is decremental and very prone to alterations in autonomic tone. Conduction through the His-Purkinje system (HPS) is via fast channel tissue and typically not that dependent on autonomic perturbations. Applying these principles, when the sinus rate is stable and then heart block suddenly occurs preceded by even a subtle slowing of heart rate, it typically is caused by increased vagal tone, and block occurs in the AV node. Heart block with activity strongly suggests block in the HPS. Enhanced sympathetic tone and reduced vagal tone can facilitate induction of both AV and atrioventricular node reentry.

Keywords: AV node; AV node reentry; Autonomic nervous system; Conduction; His-Purkinje system; Parasympathetic; Sympathetic; WPW reentry.

Publication types

Review

MeSH terms

Atrioventricular Node*
Electrocardiography
Heart Block*
Heart Rate
Humans