Atrial Structure and Fibres: Morphologic Bases of Atrial Conduction

The relationship between anatomy and function has long been recognised. Understanding the gross structure, and the myoarchitecture, of the atriums is fundamental to investigations into the substrates and therapy of atrial fibrillation. Based primarily on our experience with normal human hearts, this review provides, firstly, a basis of comparison of gross structures as seen in the clinical situation, and in animals commonly used in experimental studies. Secondly, we discuss the general arrangement of myocardial fibres with respect to gross topography in the normal human heart. The right atrium is dominated by an extensive array of pectinate muscles within the extensive appendage, whereas the left atrium is relatively smooth-walled, with a much smaller tubular appendage. Myoarchitecture displays parallel alignment of fibres along distinct muscle bundles, such as the terminal crest and Bachmann's bundle. Within the smooth wall of the left atrium, there is a marked transmural change in the orientation of the muscular fibres. Abrupt changes in orientation, and mixed arrangements, are common between bundles. Other than Bachmann's bundle, the muscular bridges which provide interatrial connections, and connections between the left atrium and the coronary sinus and inferior caval vein, are highly variable. Inhomogeneities both in gross structure and myoarchitecture are common in the normal heart. These should be taken into account when investigating hearts from patients known to have had a history of arrhythmias, in devising computer models, or when refining diagnostic and therapeutic strategies.