Last edited: 8/10/2021
1. INTRINSIC CARDIAC CONDUCTION SYSTEM
Electrophysiology: Intrinsic Cardiac Conduction System
OUTLINE
I) DEFINITION
II) MECHANISM OF DEPOLARIZATION
III) MECHANISM OF REPOLARIZATION
IV) REPOLARIZATION/RELAXATION
V) TYPES OF NODAL CELLS
VI) REVIEW QUESTIONS
VII) REFERENCES
I) DEFINITION
Generation and conduction of action potentials by non-
contractile myocardial cells (SA node, AV node, bundle of
his, bundle branches and purkinje fibers) that lead to
stimulation of contractile myocardial cells causing
contraction.
Non-contractile myocardial cells (nodal cells)
o Can generate action potentials spontaneously and
depolarize contractile myocardial cells causing them
to contract
Figure 1. The conduction system [ECGWaves]
II) MECHANISM OF DEPOLARIZATION
Take effects in nodal and contractile cells
(A) SODIUM CHANNELS
(1) Funny 𝑵𝑵𝑵𝑵+ channels (𝑰𝑰𝒇𝒇 )
These channels are open when the cell is at rest
Allows more slow movement of Na+ to move into cell
making inside of cell +
Allows less slow movement of K+ to move out of cell
making inside of cell +
This increasing + charge moves the resting membrane
potential (−60mv) → −55mv this voltage stimulates
T-type
INTRINSIC CARDIAC CONDUCTION SYSTEM
Medical Editor: Dr. Sofia Suhada M. Uzir
(B) CALCIUM CHANNELS
(1) T-type Ca++ Channels
These channels open at -55mv
They allow calcium to move into cell making inside of cell
more +
This increasing + charge in the cell moves voltage from
−55mv → −40mv
−40mv is the threshold voltage to stimulate L-type
calcium channels
(2) L-type Ca++ Channels
These channels open at −40mv
They allow explosive influx of calcium ions into cell
making cell way more ++
This increasing + charge in the cell moves voltage from
−40mv → +40mv
This calcium influx depolarizes the nodal cell
These calcium ions move from the depolarized nodal cell
into adjacent contractile myocardial cell via intercalated
discs
(i) Gap junctions
o Connexin proteins
o Channel proteins between two nodal cells
(ii) Desmosomes
o Proteins that link two nodal cells tightly together
When calcium enters adjacent contractile myocardial cells
via intercalated discs this causes the myocardial cell to
go from Resting Membrane Potential of −90mv→ −70mv
which is threshold potential in these cells.
The voltage of −70mv in contractile myocardial cells in
threshold to stimulate voltage gated Na+ channels
(C) VOLTAGE GATED CHANNELS
(1) Voltage gated 𝑵𝑵𝑵𝑵+ channels
These channels open at a threshold voltage of −70mv
When open Na+ explosively rushes into contractile
myocardial cells causing inside of cell to become super
+++ inside of cell goes from −70mv→+10mv
This increasing + charge in the cell causes it to depolarize
and move along the cell membrane or sarcolemma of
contractile myocardial cell
This activates L-type calcium channels on the
sarcolemma and T-tubules of contractile myocardial cell
(D) CHANNELS ON CONTRACTILE MYOCARDIAL
CELLS
(1) L-type Ca++ channels on contractile myocardial
cell
These are activated by voltage gated Na+ channels
moving voltage to +10 mv
Calcium rushes into cell via these channels and activates
proteins on sarcoplasmic reticulum (SR)
o Ca++ stimulates Ryanodine receptor type 2 causing
 Ca++ to move from SR into cytoplasm of muscle
cell
o This rise of intracellular calcium causes
 Muscle contraction
o Calcium + troponin C + troponin T changes shape of
tropomyosin
CARDIOVASCULAR PHYSIOLOGY : Note #1. 1 of 4
  Opens up actin heads allows myosin to bind actin
head if ATP is present the myosin pulls the actin
heads
 Causes contraction of the muscle
III) MECHANISM OF REPOLARIZATION
Take effects in nodal cells
Also, calcium in the cell is shunted back into the
sarcoplasmic reticulum or out of cell to prevent any
further prolonged contraction
(i) Into SR:
o ATP dependent Ca++/H+ exchanger
o Na+/ Ca++ exchanger via secondary active transport

(ii) Out of cell:

o ATP dependent Ca++/H+ exchanger
o Na+/ Ca++ exchanger via secondary active transport
So now that K+ is leaving the cell and no Ca++ is entering
o The voltage drops from 0mv→ −90mv
 Which is the resting membrane potential of the
contractile myocardial cell

Figure 2. Repolarization graph [Wikipedia]

(1) After nodal depolarization

After nodal cells have depolarized and allowed Ca++ to
move via intercalated discs to nearby myocardial cells
now the nodal cell starts to relax
If you remember the voltage at the peak of nodal cell
depolarization was +40mv
(2) At +40mv
Figure 3. Types of nodal cells [TeachPE]
Voltage gated K+ channels in nodal cells opens
K+ leaves the cell
o Makes inside of cell increasingly negative
The inside of the cell goes from +40mv→ −60mv where
the resting membrane potential is
Now the nodal cell is ready to be stimulated again via
Funny Na+ channels

IV) REPOLARIZATION/RELAXATION
Take effects in contractile myocardial cells
If you remember the voltage at the peak of contractile cell
depolarization was +10mv
(1) At +10mv
This stimulates
o Voltage gated K+ channels in contractile myocardial
cells
o K+ moves out of the cell this makes inside of cell
negative
HOWEVER, if you remember the L-type Ca++ channels
are also open at +10mv, so:
o Ca++ is entering the cell as K+ is leaving the cell
After +10mv is reached more K+ leaves than Ca++ enters
o This moves voltage from +10mv→0mv
(2) At 0mv
o K+ leaves at the same rate that calcium enters the
cell → this keeps the voltage PLATEAUED at 0mv for
a small time period
After contraction has finished the L-type Ca++ channels
close and now only K+ is moving across the cell not
Ca++
Figure 4. Electrical activity of myocardium [ResearchGate]

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 V) TYPES OF NODAL CELLS
Listed in order of sequence of conduction pathway

Table 1. Types of nodal cells

Nodal Cells Location Function Intrinsic rate
SA node Near the entrance of SVC into right Pacemaker of the heart 60-80
atrium Sets the sinus rate and rhythm beats/min

AV node At the top of the interventricular Receives impulses from SA node 40-50
septum Conducts impulses very slowly beats/min
Superior and medial to entrance of (0.1 second delay)
coronary sinus into right atrium This delay prevents simultaneous atria and
ventricular contraction
Fewer gap junctions
Small diameter cells

Bundle of Inferior to AV node in the Receives impulses from AV Node 30-40

His membranous part of interventricular Reduces high frequency impulses from traveling beats/min
septum into ventricles from atria in conditions like atrial
fibrillation

Bundle Right and left bundle branches span Receives impulses from bundle of his 30-40
Branches along the length of interventricular Right Bundle sends impulses to right ventricle beats/min
septum until the apex. Left Bundle sends impulses left ventricle

Purkinje Terminal conducting fibers located in Receives impulses from bundle branches 30-40
Fibers the sub endocardial layer of Makes sure the entire ventricular myocardium beats/min
myocardium in the right and left contracts as a unit (syncytium)
ventricles Contains tons of gap junctions transmits impulses
very fast

On an EKG the P-wave represents what area of the

VI) REVIEW QUESTIONS heart?
What area of the heart’s electrical conduction is a. Left bundle branch
known as the “pacemaker” of the heart? b. AV node
a. SA node c. Bachmann’s Bundle
b. AV node d. SA node
c. Purknije Fibers
d. Bundle of His
Which structure in the heart does NOT propagate
action potentials?
What area of the heart is responsible for the delay of
a. The sinus node
conduction between the artrium and ventricles?
b. The AV node
a. AV node
c. The annulus fibrosus
b. Bundle of His
d. The atrial septum
c. Bachmann’s Bundle
e. The ventricular septum
d. Right bundle branch
In which structure is propagation of the action
True or False: Bachmann’s bundle is located in the
potential the fastest in the heart?
left atrium.
a. The sinus node
a. True
b. The AV node
b. False
c. The bundle of His
d. The atrial myocardium
True or False: Depolarization of the heart muscle is
e. The ventricular myocardium
when the muscle contracts and repolarization is
when the heart muscle rests.
In which structure is propagation of the action
a. True
potential the slowest in the heart?
b. False
a. The sinus node
b. The A V-node
The SA node fires at a rate of?
c. The bundle of His
a. 80-90 bpm
d. The atrial myocardium
b. 40-60 bpm
e. The ventricular myocardium
c. 60-100 bpm
d. 60-80 bpm
In which structure in the heart is there a plateau in
the cardiac action potential?
a. The sinus node
b. The A V-node
c. The annulus fibrosus
d. The atrial myocardium
e. The ventricular myocardium

INTRINSIC CARDIAC CONDUCTION SYSTEM CARDIOVASCULAR PHYSIOLOGY : Note #1. 3 of 4

 VII) REFERENCES
● ECGWaves. ECG& Echo Learning. [digital image]
https://ecgwaves.com/topic/introduction-electrocardiography-ecg-
book/
● Teach PE. Heartbeat & Cardiac Conduction System. [Digital
image] https://www.teachpe.com/anatomy-physiology/the-heart-
conduction-system
● Wikipedia. Repolarization. 2013 [digital image]
https://en.m.wikipedia.org/wiki/Repolarization
● ResearchGate. Electrical Activity of Myocardium. Alila Sao
Mai/Shutterstock.com. [digital image]
https://www.researchgate.net/figure/The-depolarization-and-
repolarization-of-the-heart-Credit-Alila-Sao_fig7_265168561
● Electrical Conduction System of Heart [Quiz]
https://www.registerednursern.com/quiz-on-the-electrical-
conduction-system-of-the-heart-anatomy-pathophysiology/
● The Cardiac Conduction System. Basic Physiology [Quiz]
http://basicphysiology.com/B.%20Cardiovascular%20System/B.3.%
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● Le T, Bhushan V, Sochat M, Chavda Y, Zureick A. First Aid for
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● Hill M. Cardiovascular System - Heart Histology.
https://embryology.med.unsw.edu.au/embryology/index.php/Cardiov
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● Ostenfeld E, Flachskampf FA. Assessment of right ventricular
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● Klabunde RE. Hemorrhagic Shock.
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