2020, Number 4
<< Back Next >>
CorSalud 2020; 12 (4)
The normal sinus node: What we know now
Carmona PR, Lorenzo ME
Language: Spanish
References: 39
Page: 415-424
PDF size: 686.46 Kb.
ABSTRACT
The sinus node is the physiological pacemaker of the heart. Different pathophysiological conditions lead to a reduction of its function, which is clinically called sinus dysfunction. However, for a better understanding of its disease state, it is necessary to elucidate how it works under normal conditions. New evidences indicate that the automatism of the sinus node is produced by the interaction of the membrane clock and the calcium clock, which gives it a strong character that protects it against malfunctions. Current evidences on cell synchrony within the sinus node are presented, as well as the form of electrical propagation and the source-sink coupling. In addition, recent anatomical and histological findings are described.
REFERENCES
Peters CH, Sharpe EJ, Proenza C. Cardiac pacemaker activity and aging. Annu Rev Physiol. 2020;82:21-43.
Ho SY, Sánchez-Quintana D. Anatomy and pathology of the sinus node. J Interv Card Electrophysiol. 2016;46(1)3-8.
Costanzo L. Physiology. 6ª ed. Philadelphia: Elsevier; 2018.
Boron W, Boulpaep E. Medical physiology. 3ª ed. Philadelphia: Elsevier; 2016.
Gómez-Torres FA, Sebastian R, Ruíz-Sauri A. Morphometry and comparative histology of sinus and atrioventricular nodes in humans and pigs and their relevance in the prevention of nodal arrhythmias. Res Vet Sci. 2020;128:275-85.
Nooma K, Saga T, Iwanaga J, Tabira Y, Watanabe K, Tubbs RS, et al. A novel method with which to visualize the human sinuatrial node: Application for a better understanding of the gross anatomy of this part of the conduction system. Clin Anat. 2020;33(2):232-6.
Latarjet M, Ruiz L. Anatomía humana. 3ª ed. Barcelona: Médica Panamericana; 1999.
Petrescu CI, Niculescu V, Ionescu N, Vlad M, Rusu MC. Considerations on the sinus node microangioarchitecture. Rom J Morphol Embryol. 2006;47(1):59-61.
Lopes AC, DiDio LJ, Buffolo E. Anatomical and clinical aspects of the blood supply of the sinoatrial node. Rev Assoc Med Bras (1992). 1998;44(1):47-9.
Issa ZF, Miller JM, Zipes DP. Clinical arrhythmology and electrophysiology: A companion to Braunwald's heart disease. 3ª ed. Philadelphia: Elsevier; 2019.
Pauza DH, Rysevaite-Kyguoliene K, Pauziene N. Innervation of the sinoatrial node. En: Zipes DP, Jalife J, Stevenson W, editores. Cardiac electrophysiology: From cell to bedside. 7ª ed. Philadelphia: Elsevier; 2018. p. 356-61.
Kirkman E. Initiation and regulation of the heartbeat. Anaesth Intens Care Med. 2009;10(8):377-80.
Lau DH, Roberts-Thompson KC, Sanders P. Sinus node revisited. Curr Opin Cardiol. 2011;26(1):55-9.
Gómez-Torres FA, Ballesteros-Acuña LE, Ruíz-Sauri A. Histological and morphometric study of the components of the sinus and atrioventricular nodes in horses and dogs. Res Veter Sci. 2019;126:22-8.
Monfredi O, Tsutsui K, Ziman B, Stern MD, Lakatta EG, Maltsev VA. Electrophysiological heterogeneity of pacemaker cells in the rabbit intercaval region, including the SA node: insights from recording multiple ion currents in each cell. Am J Physiol Heart Circ Physiol. 2018;314(3):H403-14.
Mitrofanova LB, Gorshkov AN, Konovalov PV, Krylova JS. Telocytes in the human sinoatrial node. J Cell Mol Med. 2018;22(1):521-32.
Choudhury M, Boyett MR, Morris GM. Biology of the sinus node and its disease. Arrhythm Electrophysiol Rev. 2015;4(1):28-34.
Kane AE, Howlett SE. Differences in cardiovascular aging in men and women. En: Kerkhof PLM, Miller VM, editors. Sex-specific analysis of cardiovascular function. Switzerland: Springer, Cham; 2018. p. 389-411.
Davies MJ, Pomerance A. Quantitative study of ageing changes in the human sinoatrial node and internodal tracts. Br Heart J. 1972;34(2):150-2.
Lang D, Glukhov AV. Functional microdomains in heart's pacemaker: A step beyond classical electrophysiology and remodeling. Front Physiol [Internet]. 2018 [citado 15 Jul 2020];9:1686. Disponible en: https://pubmed.ncbi.nlm.nih.gov/30538641/
Li N, Csepe TA, Hansen BJ, Dobrzynski H, Higgins RSD, Kilic A, et al. Molecular mapping of sinoatrial node HCN channel expression in the human heart. Circ Arrhythm Electrophysiol. 2015;8(5):1219-27.
Lee CH, MacKinnon R. Structures of the human HCN1 hyperpolarization-activated channel. Cell. 2017;168(1-2):111-20.e11.
Robertson GA. It's not funny: How changes in If limit maximum heart rate with aging. J Gen Physiol. 2017;149(2):177-9.
Kozasa Y, Nakashima N, Ito M, Ishikawa T, Kimoto H, Ushijima K, et al. HCN4 pacemaker channels attenuate the parasympathetic response and stabilize the spontaneous firing of the sinoatrial node. J Physiol. 2018;596(5):809-25.
DiFrancesco D. A brief history of pacemaking. Front Physiol [Internet]. 2019 [citado 17/07/2020];10:1599. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6987461/
Sun Y, Timofeyev V, Dennis A, Bektik E, Wan X, Laurita KR, et al. A singular role of IK1 promoting the development of cardiac automaticity during cardiomyocyte differentiation by IK1-induced activation of pacemaker current. Stem Cell Rev Rep. 2017;13(5):631-43.
Chen K, Zuo D, Wang SY, Chen H. Kir2 inward rectification-controlled precise and dynamic balances between Kir2 and HCN currents initiate pacemaking activity. FASEB J. 2018;32(6):3047-57.
Cheng H, James AF, Boyett MR, Hancox JC. Cardiac background sodium current: Elusive but important. Channels. 2017;11(1):3-4.
Carmeliet E. Pacemaking in cardiac tissue. From IK2 to a coupled-clock system. Physiol Rep [Internet]. 2019 [citado 20/07/2020];7(1):e13862. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6317064/
Kohajda Z, Tóth N, Szlovák J, Loewe A, Bitay G, Gazdag P, et al. Novel Na+/Ca2+ exchanger inhibitor ORM-10962 supports coupled function of funny-current and Na+/ Ca2+ exchanger in pacemaking of rabbit sinus node tissue. Front Pharmacol [Internet]. 2019 [citado 20/07/2020];10:1632. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7000430/
Yue X, Hazan A, Lotteau S, Zhang R, Torrente AG, Philipson KD, et al. Na/Ca exchange in the atrium: Role in sinoatrial node pacemaking and excitation-contraction coupling. Cell Calcium [Internet]. 2020 [citado 21/07/2020];87:102167. Disponible en: https://doi.org/10.1016/j.ceca.2020.102167
Tse G, Liu T, Christien Li KH, Laxton V, Wong AO, Fiona Chan YW, et al. Tachycardia-bradycardia syndrome: Electrophysiological mechanisms and future therapeutic approaches (Review). Intern J Mol Med. 2017;39(3):519-26.
Mezzano V, Liang Y, Wright AT, Lyon RC, Pfeiffer E, Song MY, et al. Desmosomal junctions are necessary for adult sinus node function. Cardiovasc Res. 2016;111(3):274-86.
Kim MS, Maltsev AV, Monfredi O, Maltseva LA, Wirth A, Florio MC, et al. Heterogeneity of calcium clock functions in dormant, dysrhythmically and rhythmically firing single pacemaker cells isolated from SA node. Cell Calcium. 2018;74:168-79.
Tsutsui K, Monfredi OJ, Sirenko-Tagirova SG, Maltseva LA, Bychkov R, Kim MS, et al. A coupled-clock system drives the automaticity of human sinoatrial nodal pacemaker cells. Sci Signal [Internet]. 2018 [citado 22/07/2020];11(534):eaap7608. Disponible en: https://doi.org/10.1126/scisignal.aap7608
Hansen BJ, Csepe TA, Fedorov VV. Mechanisms of normal and dysfunctional sinoatrial nodal excitability and propagation. En: Zipes D, Jalife J, Stevenson W, editores. Cardiac electrophysiology: From cell to bedside. 7th ed. Philadelphia: Elsevier; 2018. p. 259-71.
Kalyanasundaram A, Li N, Hansen BJ, Zhao J, Fedorov VV. Canine and human sinoatrial node: differences and similarities in the structure, function, molecular profiles, and arrhythmia. J Veter Cardiol. 2019;22:2-19.
Bressan M, Henley T, Louie JD, Liu G, Christodoulou D, Bai X, et al. Dynamic cellular integration drives functional assembly of the heart's pacemaker complex. Cell Rep. 2018;23(8):2283-91.
Li N, Hansen BJ, Csepe TA, Zhao J, Ignozzi AJ, Sul LV, et al. Redundant and diverse intranodal pacemakers and conduction pathways protect the human sinoatrial node from failure. Sci Transl Med [Internet]. 2017 [citado 22/07/2020];9(400):eaam5607. Disponible en: http://doi.org/10.1126/scitranslmed.aam5607