Jun 2026· Medecine sciences : M/S· Vol 42 6-7, pp.
579-589
· 0 citations· 43 references
Medicine
TL;DR
The structure-function relationship between the morphogenesis of the ventricular conduction system and conduction defects is highlighted, and recent data on the origin, development, and regeneration of the Purkinje fiber network is discussed.
Abstract
Ventricular arrhythmias often originate in the Purkinje system, a network of specialized cardiomyocytes located on the luminal surface of the ventricles. The Purkinje system is part of the ventricular conduction system, which ensures the rapid propagation of electrical activity through the ventricles in order to synchronize their contractions. Although these cells represent only a tiny fraction of the ventricular mass, their pathogenic role is disproportionate. During embryogenesis, the ventricular conduction system arises from different populations of cardiac progenitors. Differentiation into fast-conducting cardiomyocytes occurs gradually as the ventricles develop, resulting in the formation of a single electrical circuit by the end of the fetal stage. This review highlights the structure-function relationship between the morphogenesis of the ventricular conduction system and conduction defects, and discusses recent data on the origin, development, and regeneration of the Purkinje fiber network.
The cardiac conduction system (CCS) is a hierarchically organized yet structurally heterogeneous network of specialized tissues that initiates and coordinates cardiac electrical activation. The CCS arises from region-specific cellular phenotypes, graded structural transitions, and spatially heterogeneous intercellular coupling that together enable robust cardiac excitation. This review synthesizes anatomical, histological, electrophysiological, and imaging evidence to provide a multiscale description of the human CCS. We describe the sinoatrial node as a protected pacemaker complex stabilized by fibrous insulation, cellular heterogeneity, and discrete exit pathways that regulate atrial activation. Interatrial conduction occurs through aligned atrial myocardium, with the interatrial bundle and posterior connections supporting rapid activation without strict insulation. The atrioventricular node enables physiological delay through slow, yet safe conduction shaped by specialized cellular architecture, connexin gradients, and dual-pathway organization. Distal to the node, the atrioventricular bundle and its branches - collectively known as the His-Purkinje system - deliver rapid, synchronous ventricular activation through fibrous-insulated pathways, with the Purkinje-ventricular junction acting as an inherent source-sink discontinuity that supports reliable excitation but also predisposes to conduction delay and ectopic activity. Such an integrated understanding of the CCS is essential for applications including optimization of cardiac pacing therapies, as well as for the development of physiologically accurate cardiac digital twins for patient-specific modeling, thereby supporting both clinical decision-making and mechanistic representation of cardiac activation. By consolidating dispersed experimental and conceptual insights into a single framework, this review is intended as a reference for clinicians, researchers, and engineers working at the interface of cardiac electrophysiology, clinical application, and computational modeling.
M. Kariman, B. Pretterklieber, Michael L Pretterklieber et al.· Annals of Anatomy· 0 citations