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Subepicardial and endocardial myocardial layers within the roof of the left atrium

Published:November 15, 2020DOI:https://doi.org/10.1016/j.hrthm.2020.11.014
      It is exactly 100 years since James Papez published his seminal work on the musculature of the atrial chambers.
      • Papez J.W.
      Heart musculature of the atria.
      As he explained in his introduction, information regarding the spread of the cardiac impulse was relatively new, as only in the previous decade had Keith and Flack demonstrated the location of the sinus node.
      • Keith A.
      • Flack M.
      The form and nature of the muscular connections between the primary divisions of the vertebrate heart..
      Papez aimed to show how the arrangement of the atrial cardiomyocytes underscored the spread of the impulse throughout the atrial walls.
      • Papez J.W.
      Heart musculature of the atria.
      Our interest in the atrial myocardium initially was focused on the mechanics of atrial contraction, although we still recognized the importance of the arrangement of the cardiomyocytes in underscoring conduction. In our initial study, published in 1995,
      • Wang K.
      • Ho S.Y.
      • Gibson D.G.
      • Anderson R.H.
      Architecture of atrial musculature in humans.
      we also commented on the lack of any additional anatomic investigations into the atrial myocardium subsequent to the study of Papez. Our ongoing investigations were prompted by the recognition that atrial fibrillation could be treated in the catheter laboratory. The last of these investigations appeared in 2002.
      • Ho S.Y.
      • Anderson R.H.
      • Sánchez-Quintana D.
      Atrial structures and fibres: morphologic bases of atrial conduction.
      Since then, despite the ongoing development of therapeutic interventions in the catheter laboratory, little more has been reported regarding the manner of aggregation of the cardiomyocytes in the atrial walls. This is about to change. In this issue of Heart Rhythm Journal, Pambrun et al from Bordeaux describe their pilot studies using microcomputed tomography validated by histology, promising that much more is to follow.
      • Pambrun T.
      • Duchateau J.
      • Delgrove A.
      • et al.
      Epicardial course of the septopulmonary bundle: anatomical considerations and clinical implications for roof line completion.
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      References

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        Heart musculature of the atria.
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        • et al.
        Epicardial course of the septopulmonary bundle: anatomical considerations and clinical implications for roof line completion.
        Heart Rhythm. 2021; 18: 349-357
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        The rational for isolation of the left atrial pulmonary venous component to control atrial fibrillation: a review article.
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