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Gross structure of the atriums: more than an anatomic curiosity?
Siew Yen Ho1, Robert H Anderson, Damian Sánchez-Quintana
1Faculty of Medicine, National Heart & Lung Institute, Imperial College of Science, Technology and Medicine, and Royal Brompton and Harefield NHS Trust, London. yen.ho;vaic.ac.uk
Insights
Understanding atrial anatomy is crucial for treating arrhythmias. This review details the atriums, septum, and veins, highlighting differences in animal models for improved electrophysiological mapping and interventions.
Area of Science:
- Cardiovascular Anatomy
- Electrophysiology
Background:
- Limited literature exists on atrial chamber anatomy despite its importance in atrial arrhythmias.
- Electrophysiological mapping and interventional treatments necessitate a thorough understanding of atrial structures.
Purpose of the Study:
- To review the gross anatomy of the atriums, septum, and great veins.
- To provide insights relevant to electrophysiological mapping and interventional procedures for atrial arrhythmias.
- To highlight anatomical differences between human, porcine, and canine hearts.
Main Methods:
- Review of gross anatomical structures of the human heart.
- Comparative analysis of atrial anatomy in human, porcine, and canine models.
Main Results:
- The right and left atriums exhibit distinct appendages; the right atrium has prominent musculature and pectinate muscles, while the left atrium has smoother walls.
- The atrial septum is primarily composed of the oval fossa and its rim.
- Atrial musculature extends to the pulmonary veins and superior caval vein, forming significant sleeves.
Conclusions:
- Atrial anatomy has direct practical implications for mapping and interventional procedures.
- Understanding these anatomical details is essential for successful treatment of atrial arrhythmias.
- Highlighting interspecies differences aids in the use of animal models for research.
Abstract:
Despite the extensive literature concerning atrial arrhythmias, there are relatively few articles on the anatomy of the atrial chambers. Since electrophysiological mapping and interventional treatments of atrial arrhythmias involve entering the chambers, this article reviews the gross structures to provide a better understanding of the atriums, the septum, and the connecting great veins. In addition, based on the human heart, differences between porcine and canine hearts are highlighted. The right and left atriums are characterized by morphologically distinct appendages. The right atrium contains prominent muscular bundles and an extensive array of pectinate muscles. The distal ramifications of the terminal crest lead to the "flutter" isthmus. By contrast, the left atrium has relatively smooth walls. The atrial septum is limited to the valve of the oval fossa and its immediate muscular rim. Atrial musculature extends beyond the veno-atrial junctions to the outside of the pulmonary veins. The longest sleeves are around the upper pulmonary veins, and similar sleeves are seen around the superior caval vein. The structure of the atrium is more than an anatomic curiosity. It has practical implicationsfor mapping and interventional procedures.