The impulse-conducting system (Fig. 1.

6) con
sists of specialized cells that initiate the heart
beat and electrically coordinate contractions of
the heart chambers. The sinoatrial (SA) node
is a small mass of specialized cardiac muscle fifi -
bers in the wall of the right atrium. It is located
to the right of the superior vena cava entrance
and normally initiates the electrical impulse for
contraction. The atrioventricular (AV) node
lies beneath the endocardium in the inferopos
terior part of the interatrial septum.
Distal to the AV node is the bundle of His,
which perforates the interventricular septum
posteriorly. Within the septum, the bundle
of His bifurcates into a broad sheet of fifi bers
that continues over the left side of the septum,
known as the left bundle branch, and a com
pact, cablelike structure on the right side, the
right bundle branch.
The right bundle branch is thick and deeply
buried in the muscle of the interventricular
septum and continues toward the apex. Near
the junction of the interventricular septum
and the anterior wall of the right ventricle,
the right bundle branch becomes subendocar
dial and bifurcates. One branch travels across
the right ventricular cavity in the moderator
band, whereas the other continues toward the
tip of the ventricle. These branches eventu
ally arborize into a fifi nely divided anastomo
sing plexus that travels throughout the right
ventricle.
Functionally, the left bundle branch is di
vided into an anterior and a posterior fascicle
and a small branch to the septum. The ante
rior fascicle runs anteriorly toward the apex,
forming a subendocardial plexus in the area
of the anterior papillary muscle. The posterior
fascicle travels to the area of the posterior pap
illary muscle; it then divides into a subendo
cardial plexus and spreads to the rest of the
left ventricle.
The subendocardial plexuses of both ven
tricles send distributing Purkinje fifi bers to
the ventricular muscle. Impulses within the
His–Purkinje system are transmitted fifi rst to
the papillary muscles and then throughout
the walls of the ventricles, allowing papillary
muscle contraction to precede that of the ven
tricles. This coordination prevents regurgita
tion of blood flfl ow through the AV valves, as
discussed earlier.