Cardiac pathologists and electrophysiologists have studied the atrioventricular (AV) node since 1906, when Tawara 1 Tawara S. Das Reitzleitungssystem des Saugetierherzens: Eine anatomisch-histologische Studie uber das Atrioventrikularbundel und die Purkinjeschen Faden. Gustav Fischer, Jena, Germany1906: 135-136 Google Scholar described its inferior extensions in the human heart. One century later, this important cardiac structure still carries the reputation of a profound enigma, invoked as the riddle of Sphinx, by means of its electrophysiological properties during both normal conduction and reentrant tachycardia. 2 Katritsis D.G. The human atrioventricular node: oedipus and the riddle of the Sphinx. Arrhythm Electrophysiol Rev. 2020; 9: 52-53 Crossref PubMed Scopus (0) Google Scholar In recent years, considerable evidence has accrued pertaining to its anatomic structure, 3 Inoue S. Becker A.E. Posterior extensions of the human compact atrioventricular node: a neglected anatomic feature of potential clinical significance. Circulation. 1998; 97: 188-193 Crossref PubMed Scopus (271) Google Scholar , 4 Hikspoors J. Macias Y. Tretter J.T. et al. Miniseries 1–part I: the development of the atrioventricular conduction axis. Europace. 2022; 24: 432-442 Crossref PubMed Scopus (1) Google Scholar , 5 Macias Y. de Almeida M.C. Tretter J.T. et al. Miniseries 1–part II: the compara-tive anatomy of the atrioventricular conduction axis. Europace. 2022; 24: 443-454 Crossref PubMed Scopus (3) Google Scholar , 6 Anderson R.H. Sanchez-Quintana D. Mori S. Cabrera J.A. Back Sternick E. Re-evaluation of the structure of the atrioventricular node and its connections with the atrium. Europace. 2020; 22: 821-830 Crossref PubMed Scopus (32) Google Scholar along with the electrophysiological properties, which have allowed identification of the so-called fast and slow pathways involved in atrioventricular nodal reentrant tachycardia (AVNRT). 7 Katritsis D.G. Josephson M.E. Classification, electrophysiological features and therapy of atrioventricular nodal reentrant tachycardia. Arrhythm Electrophysiol Rev. 2016; 5: 130-135 Crossref PubMed Scopus (29) Google Scholar , 8 Katritsis D.G. A unified theory for the circuit of atrioventricular nodal re-entrant tachycardia. Europace. 2020; 22: 1763-1767 Crossref PubMed Scopus (7) Google Scholar , 9 Katritsis D.G. Calkins H. Anderson R.H. The specialized atrioventricular ring tissues participate in the circuit of atrioventricular nodal reentrant tachycardia. J Am Heart Assoc. 2021; 10e022811 Crossref Scopus (0) Google Scholar But still the nature of these patterns of conduction in the context of sinus rhythm, as opposed to those observed during tachycardia, remains obscure. In the great Sophoclean tragedy, in light of its insurmountable difficulty, the denouement of the riddle of Sphinx by mortal Oedipus was initially perceived by the Athenians as a form of hubris against the gods by a human. 10 Sophocles. Oedipus Tyrannus. 429 BC. Google Scholar We believe that the accumulation of recent anatomic and electrophysiological evidence now enables us to provide the rationale for solving the nodal riddle without committing scientific hubris.
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