CONDUCTING SYSTEM OF HEART

CARDIAC ACTION POTENTIAL

Phase 0: Rapid depolarization.

Greatly increased positivity with reference to exterior due

to influx of large amounts of Na+ ions.

At −30 to −40 mV membrane potential the calcium channels

also open up and influx of Ca2+ ions also contributes in this
phase.

Duration of depolarization is 2 ms and is followed by

repolarization which occurs in three phases.
Phase 1: Initial rapid repolarization.

Very short-lived slight rapid repolarization. The membrane

potential reaches from +30 mV to −10 mV during this
phase. The initial rapid repolarization is due to closure of
Na+ channels and opening of K+ channels resulting in
transient outward current.
Phase 2: Plateau

the cardiac muscle fibre remains in the depolarized state.

The membrane potential falls very slowly only to −40 mV
during this phase. The plateau lasts for about 100−200 ms.

Very slow repolarization during the plateau phase is due to:

• Slow entry of Ca2+ ions in cytosol resulting from opening

of sarcolemmal L-type Ca2+ channels.

• Closure of a distinct set of K+ channels ( called the

inward rectifying K+ channels )
Phase 3: Repolarization.

Complete repolarization occurs and the membrane

potential falls to the approximate resting value. This phase
lasts for about 50 ms.
The slow repolarization results from the closing of Ca2+
channels and opening of following two types of K+
channels.

• Delayed outward rectifying K+ channels, which are

voltage-gated and are activated slowly.

• Ca2+ activated k+ channels which are activated by the

elevated sarcoplasmic Ca2+ levels.
Phase 4: Resting potential

In this phase of resting membrane potential (also called as

polarised state), the potential is maintained at −90 mV
Ionic basis. The resting membrane potential is maintained
by a resting K+ current, the largest contributor to which is
the inward rectifying K+ current. The resting ionic
composition is restored by Na+−K+ ATPase pump.
Duration of action potential
HR ~ 75 beats/min  250 ms.

Action potential duration decreases with increased heart

rate.

HR ~ 200 beats/min  150 ms

Spread of action potential through cardiac muscle

The cardiac muscle acts as a physiological syncytium due

to the presence of gap junctions amongst the cardiac
muscle fibres. Because of this, the action potential spreads
through the cardiac muscles very rapidly. Further, as there
are two syncytia (the atrial and the ventricular) in the
heart, so the action potential is transmitted from atria to
ventricles only through the fibres of specialized conductive
system.
Cardiac slow action potential

Or

Origin of Cardiac impulse

Cardiac slow action potential
Phase 4: Pacemaker potential-prepotential

The slow fibres of the pacemaker tissue have a unique

feature, i.e. leakage of resting membrane for sodium.

This occurs due to the activation of ‘h’ channels, (also

called as ‘f’ channels) as a result of unusual or funny
activation following hyperpolarization of the membrane
(while the resting membrane of fast fibres is relatively
impermeable to Na+).
This causes slow diffusion of Na+ into the SA nodal fibres
under resting condition. This slow entry of Na+ in the cells
slowly raises the potential to −55 mV (i.e. causes slow
depolarization).

This slow depolarization forms the initial part of pacemaker

potential.
Then the ‘T (transient) calcium channels’ open up and
there is slow influx of Ca2+ causing further depolarization
in the same at slower rate till a threshold level of −40 mV is
reached.

Thus, calcium current (Ica) due to opening of ‘T calcium

channels’ forms the later part of the pacemaker potential.
Phase 0:

At the threshold level (−40 mV) the ‘L (long lasting) calcium

channels’ open up and the action potential starts with a
rapid depolarization due to influx of Ca2+.

Thus, it is important to note that the depolarization in SA

node is mainly due to influx of Ca2+ rather than Na+.

Consequently, the depolarization is not as sharp as in the

other myocardial fibres.
Phase 3:

At the end of depolarization, voltage gated potassium

channels open up and calcium channels close. This causes
K+ to diffuse out of the fibres resulting in a rapid
repolarization from −55 to −60 mV.
Phase 4:

Again, due to an unique feature of slow fibres of the SA

node (i.e. leakage of resting membrane to Na+), the resting
potential does not become stable but slow depolarization
starts due to slow influx of Na+ making initial part of
prepotential.

And ultimately, due to repetition of the above described

steps another action potential is initiated. In this way,
impulses are generated at regular intervals of time
(autorhythmicity).
Conducting system of the Heart
&
Conduction of Cardiac impulse
The conduction system of the heart is composed of
modified cardiac muscle that has fewer striations and
indistinct boundaries.

The SA node and, to a lesser extent, the AV node,

also contain small round cells with few organelles, which
are connected by gap junctions. These are probably the
actual pacemaker cells, and therefore they are called P
cells.
The conducting system of the heart consists of specialized
fibres of the heart muscle present as

the sinoatrial node,

the interatrial tract & the internodal tracts,

the atrioventricular (AV) node,

the AV bundle of His and

its right and left terminal branches,

the subendocardial plexuses of the Purkinje fibres.

1. Sinoatrial node
Location – wall of rt. Atrium just right to SVC
opening
Dimension – 15mm x 2mm x 1mm

Function - Spontaneous rhythmical electrical impulses

arise from the SA node and spread in all directions to:

-Cardiac muscles of atria,

-Interatrial tract to left atrium and
-Internodal tracts to AV node
2. Interatrial tract (Bachman’s bundle).

Band of specialized muscle fibres that run from the SA

node to the left atrium. It causes simultaneous
depolarization of the atria.

Spread of impulse – SA node & Atria

The impulse after originating in the SA node travels over

the muscle fibres of atria and through the interatrial tract
to the left atrium.

Atrial depolarization is completed in about 0.1 s.

3. Internodal conduction pathway.

Function : conducts impulse from SA node to AV node

Anterior internodal pathway of Bachman

Middle internodal pathway of Wenckebach

Posterior internodal pathway of Thorel

4. Atrioventricular node.

Location - beneath the endocardium on the right side of

lower part of the atrial septum, near the tricuspid valve.

Function –

Impulse arrives to the AV node from the internodal

tracts and the atrial myocardium. AV node causes
conduction of the cardiac impulse to the AV bundle and
from there to the ventricles.
Conduction through AV node is slow, there is a delay of
about 0.1 s.

The causes of AV nodal delay are:

1. Transitional fibres are very small and conduction rate

is slow, i.e. 0.02−0.05 m/s.

The conduction rate of AV nodal fibres is also very

slow (0.02−0.05 m/s).

2. Very few gap junctions connecting successive fibres

in the pathway.
SA node
Internodal pathways

Transitional fibres
AV node
The ability of the AV node to slow and to block the
rapid impulse is called decremental conduction

What is decremental conduction??

The more frequently the node is stimulated the slower it

conducts. This is the property of the AV node that prevents
rapid conduction to the ventricles in cases of rapid atrial
rhythms such as atrial fibrillation or atrial flutter.

This AV nodal delay is useful, because it provides time for

completion of the atrial contraction and their emptying,
(i.e. ventricular filling) before the ventricles contract.
(4:1, 3:1 etc.)
5. Atrioventricular bundle of His and the bundle
branches.

The AV bundle arises from the AV node, descends

through the fibrous skeleton of the heart and divides
into right bundle branch for the right ventricle and the
left bundle branch for the left ventricle. The branches
break up and become continuous with the plexus of
Purkinje fibres.

Function- conducts impulse from AV node to the

purkinje fibres
6. Purkinje fibres. These are spread out deep to the
endocardium and reach all parts of the ventricles including
the bases of papillary muscles.

From the AV node the impulses are conducted

Bundle of His

Bundle branches (0.08 – 0.15 secs)

Purkinje fibres
(0.03 secs)
Ventricular muscle fibres
In humans the depolarization of ventricular muscles
proceeds as follows : -