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(Circulation. 2006;113:2775-2781.)
© 2006 American Heart Association, Inc.

Historical Perspective

Why Does the Heart Beat?

The Discovery of the Electrical System of the Heart

Mark E. Silverman, MD; Daniel Grove, MD; Charles B. Upshaw, Jr, MD

From the Department of Medicine, Emory University, and the Fuqua Heart Center of Piedmont Hospital, Atlanta, Ga.

Correspondence to Mark E. Silverman, MD, 1968 Peachtree Rd NW, Atlanta, GA 30309. E-mail marksil{at}comcast.net

Why does the heart beat? This question—known as the myogenic versus neurogenic theory—dominated cardiac research in the 19th century. In 1839, Jan Evangelista Purkinje discovered gelatinous fibers in the ventricular subendocardium that he thought were muscular. Walter Gaskell, in 1886, demonstrated specialized muscle fibers joining the atria and ventricles that caused "block" when cut and found that the sinus venosus was the area of first excitation of the heart. By examining serial embryologic sections, Wilhelm His, Jr, showed that a connective tissue sheet became a bundle connecting the upper and lower cardiac chambers, the bundle of His. Sunao Tawara traced the atrioventricular (AV) bundle of His backward to find a compact node of fibers at the base of the atrial septum and forward where it connected with the bundles of cells discovered by Purkinje in 1839. Tawara concluded that this "AV connecting system" originated in the AV node, penetrated the septum as the His bundle, and then divided into left and right bundle branches that terminated in the Purkinje fibers. Martin Flack and Arthur Keith studied the conduction system of a mole and found a structure in the sinoauricular junction that histologically resembled the AV node. They felt that this was where "the dominating rhythm of the heart normally begins" and named it the sinoauricular node in 1907. The ECG of Einthoven soon brought a new understanding to the complex electrical system that makes the heart beat. In 2006 and 2007, we celebrate the 100th anniversaries of the publication of the exciting discovery of the AV and sinus nodes, truly landmarks in our understanding of cardiac structure and physiology.

Key Words: atrioventricular node • conduction • electrical stimulation • sinoatrial node

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