ČAS OP I S L ÉK A ŘŮ Č ESK Ý C H , 145, 2006, N o.

MEDICINE HISTORY

Purkinje fibers of the Heart Conduction System

The History and Present Relevance of the Purkinje discoveries

Eliška O.
Institute of Anatomy, 1 st Medical School, Charles University Prague

SUMMARY

It has been 160 years now since Purkinje published his findings of conduction fibers in the heart in Archiv f. Ana-
tomie u. Physiologie, and 166 years since the Polish version of this publication. Even during Purkinje’s life some
anatomists had studied the morphology of these fibers, but nobody at that time understood the great physiological
and medical importance this discovery would have for medicine. This can be seen as late as the 20th century and
even today. Purkinje’s work triggered a cascade of these discoveries, which led at the beginning of the previous cen-
tury to the formulation of the basic scheme of the conduction system. Purkinje fibers or Purkinje cardiomyocytes
are part of the whole complex of the cardiac conduction system, which is today classified as specific heart muscle
tissue responsible for the generation of the heart impulses. From the point of view of their ultrastructural composi-
tion, the cells of different parts of the cardiac conduction system are largely similar. In contrast to heart contractile
cardiomyocytes, the cells of the cardiac conduction system including Purkinje fibers have a small amount of myo-
fibrils, fewer small mitochondria and thus a light cytoplasm as well as a higher glycogen content, but their T-tubu-
lar system is tiny or absent. These cells can be detected with some morphological, histochemical methods. Howe-
ver, the cells of the conduction system are not completely uniform as they differ in size, number of nexuses-gaps,
intercalary disks and in some other features in the individual parts of the conduction system. However, these specia-
lized cells work as a whole. Nowadays morphological research concerning all parts of the cardiac conduction sys-
tem, including Purkinje fibers, is focused on ultrastructural, histochemical and genetic issues, with the aim of pre-
venting and treating disturbances of the conduction system such as arrhythmias with the increasingly popular
genetic therapy - and possibly of replacing electrical pacemakers with biological ones. If Jan Evangelista Purkinje
had lived nowadays, he would have been surprised and delighted at the degree and extent of research and the clini-
cal application his discovery induced.
Key words: Purkinje fibers, morphology, history, present time. El.

Čas. Lék. čes., 2006, 145, pp. 329–335.

HISTORY OF THE DISCOVERY OF PURKINJE

T he spontaneous activity of the heart depends on specialized
myocytes located in the determined parts of the heart. These
particular myocytes, which morphologically differ in certain featu-
FIBERS – PURKINJE CARDIOMYOCYTES

res from the contractile cardiomyocytes, are able to generate spon- Jan Evangelista Purkinje was born the 18 December 1787 in
taneous impulses and conduct them to the whole heart muscle. In Libochovice (Bohemia). In 1818 he defended his doctorate and in
the heart these specialized cells are mutually connected and form an spring 1823 he became Professor of the University in Vratislav
anatomical and physiological unit, called the heart conduction sys- (Previously: Breslau, Germany; nowadays: Wroclaw, Poland),
tem. where he worked until 1850. It was during this period in Vratislav,
between the ages of 35 and 63, that he made his most important dis-
coveries. This very age generally represents the physiological
WHAT DID J. E. PURKINJE IN THE HEART? extent of the greatest creative waves of the human being. From 1850
until his death in 1869 Purkinje worked in the Institute of Physiol-
Jan Evangelista Purkinje was the first person in the world to dis- ogy in Prague, which he had founded and built up. The acquisition
cover and describe the heart conduction system, in particular its last of the big Plösl microscope in 1835 represented an important turn-
part (from the point of view of the conduction system behavior), ing point for Purkinje’s histological and embryological research.
which is called the Purkinje fibers in his honor. The fibers of this Purkinje published his discovery of a part of the heart conduction
last part run on the interior surface of the ventricles to join the system, nowadays called Purkinje fibers – Purkinje cardiomyocytes
working cardiomyocytes. Nowadays these fibers are also called (1) in 1845 in “Archiv für Anatomie, Physiologie und wis-
Purkinje heart cells or Purkinje cardiomyocytes. senschaftliche Medicin”, in the article “Mikroskopisch – neurolo-

The paper was presented as part of the Purkinje Night at the Czech Physicians’ Club in Prague on 23 May 2005.

Oldřich Eliška, M.D., DrSc.

128 00 Prague 2, U Nemocnice 3, Czech Republic,
e- mail: [email protected]

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gische Beobachtungen”. Over 15 pages the author describes neuro- clinical discoveries and papers dealing with this issue, which still
logical fibers and ganglions in various organs. Only the last two reverberates today. Owing to their localization on heart ventricles
pages deal with Purkinje heart fibers. The paper represents, as Purk- walls as described by Purkinje, these particular cardiomyocytes are
inje mentions himself, a follow-up to his previous neurohistological regarded as a final segment of the conduction system that is con-
works that had been published in Polish (2) in 1839 in Rocznik nected to normal cardiomyocytes verticular musculature and go as
wydzialu lekarskiego w uniwersytecie Jagiellonskim. Krakow, Tom far as the improper chordae tendineae. Purkinje cells have the fol-
II, pp. 44-67. Purkinje had observed the conduction fibers in lowing important morphological features: 20-70 microns of size,
sheep’s hearts. The paper was partly translated from German into spacious sarcoplasm, small amount of myofibrils localized
Czech by Professors Borovanský and Weigner in 1937 (3). Having marginally in the cell. Two years before Purkinje’s death (1867)
gone through the available literature I have not found an accurate Obermeier described three types of Purkinje cells differing in quan-
and self-contained Czech translation of this paper, so I shall take the tity of sarcoplasm and thus in compactness of myofibrils. Bigger
liberty of presenting the English (Czech) translation here. cells predominantly had a cubic shape with fewer myofibrils
marginally in the cell; they were connected to spherical cells of
The English (Czech) translation of the Journal formulation middle size having more myofibrils and finally to the cells of a long
13. Directly under the serous membrane (skin) on the interior thin shape having more striated myofibrils. He found Purkinje
walls of the sheep heart I observed firstly a network net of grey, flat fibers in hearts of sheep, horses, pigs, cows, geese and pigeons.
and gelatinous fibers that partly spreads to the papillary muscles However, he did not find them in humans, cats, hares, mice or frogs.
and to other neighboring fibrous trabeculal and that partly bridges In the heart of big animals, such as beef cattle, he observed the
furrow of the heart walls. Then, during a microscopic observation, Purkinje fibers not only under ventricle endocardium but also in the
I found these fibers are mostly formed by grains (cells) resembling ventricle muscle. (6). Obermeier suggested another name for Purk-
the cells in ganglions, which are tightly joined forming a polyedric inje fibers – Purkinje muscles chains (“Purkinje’sche Muskelket-
shape. In the interior of each grain I found one or two nuclei not of ten”). Knowledge of the conduction system and Purkinje cardio-
spherical shape, similar to the nuclei of the genuine ganglion myocytes was significantly expanded thanks to the research of
grains. In these grains I found fibers that were mutually crosswise a Japanese scientist Tawara. (7). In 1906 Sunao Tawara published
connected in the number of 5 to 10 pieces, arranged into longitudi- the results of his two and half year work in Marburg, concerning the
nal bundles of grey fibrils. Elastic tissue formed by double fibrils is conduction system, in his book: Das Reizleitungssystem des
located among the grains in the interstitium of their walls. When Säugetierherzens. Verlag Gustav Fischer, 1906 (200 pages and 10
treated with vinegar, these fibrils present transverse strips similar to color tables). Tawara’s teacher and consultant, Ludwig Aschoff
heart muscle fibrils. It is difficult to say if they represent real fibers (1866–1945) behaved very nobly as he did not mention himself as
or just contours of membranous walls which, like plant cells, sur- a co-author of the book. He had only written a foreword. Tawara
round granular contents; in my opinion the second option is more discovered the atrioventricular node (formerly called Tawara or
likely, as after crushing the grains, I could not see any similar free Aschoff Tawara node); he also histologically described in detail
fibrils. On no account can they be compared to nervous fibrils that Purkinje cells in the atrioventricular node and branches and their
may be seen in ganglions, weaving ganglion balls round, even transition to the contractile muscle. He was keen to retain the name
though it appears so at first sight. I never managed to find real ner- of Purkinje bundles and thus helped to spread the term to the whole
vous fibrils in these granular fibers, which would prove the obvious cardiologic world. He excluded some previous opinions regarding
nature of the ganglions. Purkinje fibers (cells) as a pathological structure (8). In 1908, in his
Therefore, I would incline to categorize this new tissue as carti- publication concerning the discovery of electrocardiogram,
laginous, although considering its softness, I am in doubt about its Einthoven used Tawara’s research concerning the atrioventricular
effect in the relation to a relatively huge muscle mass of the heart. conduction system, including its final bifurcation of conduction
(Thus, it is currently more likely to me to consider this tissue an fibers (or Purkinje fibers) into the heart muscle, in the interpretation
independent locomotive apparatus and to regard the membranes of the electrocardiogram (9). One of the first wax and wire recon-
surrounding the grains as muscular ones). Moreover, I found simi- structions of the atrioventricular node, branches and bifurcation of
lar granular fibers in beef, pig and horse. However, I never man- Purkinje fibers of the calf heart was effected by Lydia de Witt 1909
aged to find the same in human, dog, rabbit or hare. (10).
Although a literal translation from the German original aged 160 It has already been said that Purkinje fibers are part of the con-
years into Czech (and English afterwards) seems slightly halting duction system. Individual parts of the conduction system are locat-
from the point of view of the contemporary professional terminolo- ed in different places of the heart, e.g. in the right atrium wall, in the
gy, it is possible to deduce the following facts: interventricular septum and in the wall of both ventricles.
A) Purkinje excluded that the fibers he found were nervous fib- At this point a question arises: are all parts of the conduction
rils and ganglions. system morphologically similar or partly similar, or they are funda-
B) After some hesitation he also excluded the hypothesis of car- mentally structurally different?
tilaginous origin of the fibers.
C) He finally described the fibers as being of a muscular type
belonging to the locomotor apparatus. PARTS OF THE CONDUCTION SYSTEM –
Purkinje could not know at that time that these fibers he disco- CRONOLOGICAL DEVELOPMENT
vered and described as fibers of being a muscular type, were fibers DISCOVERIES
of the conduction system.
Purkinje’s name would possibly have gone out the window if the As it has already been said, Purkinje presented the first part of
discoverer of electric currents in the heart contraction (together the conduction system in the shape of the final network of heart fib-
with Heinrich Müller) a Swiss anatomist and physiologist Professor rils on the interior wall of sheep ventricles in 1845. The atrioven-
Rudolf Albert Kölliker (1852) had pointed these fibers out, naming tricular bundle was the second discovered part of the conduction
them Purkinje fibers. (4, 5). Since then, this term has been broadly system (11). It is called after its discoverer, an internist His Junior
accepted in international literature. The discovery of Purkinje fibers (1893), the His bundle. A similar discovery was made by Kent
launched an explosion of other morphological, physiologic and (1892–1893), who found a muscular connection between atria and

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ventricles and dissected the atrioventricular node (12). However, he Atrioventricular node – AV node
was not convinced of the importance of these bundles. The last The atrioventricular node is localized between the coronary sinus
structure of the conduction system, the sino-atrial node (13), was mouth and the septal leaflet of the tricuspid valve in Koch triangle.
discovered by Keith and Flack in 1907. It can easily be revealed by dissection. It is 5–7 mm long and
So-called atrial conduction pathways, also referred to as atrial 2–5 mm wide. Its cells can be microscopically distinguished from
preferential pathways or internodal pathways connecting the sinoa- the atrial muscle. Their structure is plexiform, they are nearly of the
trial and the atrioventricular nodes, are still a matter of contention same size as atrial cells, but their cytoplasm is lighter than in atrial
(14–16). The question is whether these pathways are formed by and ventricular myocytes. They are characterized by their striated
conductive substance or just by working cardiomyocytes. These structure and intercalated disks. Inside the node we find larger
pathways were known as early as the beginning of the 20th century. amounts of elastic and collagenous connective tissue than in atrial
They consist of an anterior pathway of Bachman (1916), running and ventricular muscle, but less than in the sinoatrial node. The
from the anterior margin of the sinoatrial node, surrounding the node is divided into two zones: a superficial one, formed by transi-
vena cava superior and in the anterior part of the interatrial septum tional cells and normal cardiomyocytes and a deep (compact) one.
running to the atrioventricular node (17). The middle preferential The cells of the compact zone are similar to nodal cells. Small nodal
pathway (Wenckebach – 1907) runs from the proximal surface of cells gradually transfer to bigger Purkinje fibers of the atrioventri-
the sinoatrial node to the dorsal part of the atrial septum up to the cular bundle. The electronogrammes of nodal cells of the AV node
limbus fossae ovalis, where it joins the anterior pathway, and show a smaller number of irregularly arranged myofibrils, a poorly
together they join the atrioventricular node (18). Finally, there is the developed sarcoplasmatic reticulum and no tubular system. Cell
posterior (inferior) preferential pathway (Thorel – 1910) that junctions are formed by a lot of desmosomes and few nexuses. We
detaches from the caudaly of the sinoatrial node, running caudad can more frequently see the fasciae adherentes than in sinuatrial
along the crista terminalis and in its inferior part entering the atri- cells, but not so often than in atrial and ventricular myocytes. For
oventricular node (18). basic data about the atrioventicular junction area see citations
(32–38).

MORFOLOGICAL STRUCTURE OF THE

INDIVIDUAL PARTS OF ATRIAL PREFERENTIAL PATHS (PATHWAYS)
THE CONDUCTION SYSTEM
Atrial Preferential Paths (Pathways)
Sinoatrial node - SA node Are they part of the conduction system?
Nowadays we generally use the term “sinoatrial node”. However, Impuls excetation preferentially and the quickest by so-called
from the embryologic point of view, the term “sinuatrial” would be preferential pathways. These pathways consist of muscular fibers,
more correct, as it is created in the part of an embryonic heart part, fibers similar to Purkinje cells and fibers similar to nodal cells,
sinus venosus. The node is situated on the junction of the anterior however these last ones are sporadic (39). Some authors (40-42) do
circumference of the vena cava superior and the right auricle, in sul- not recognize these pathways from the morphologic and physiolog-
cus terminalis. It is spindle-shaped, 5-9 mm long, 3–5 mm wide. It ic point of view as conduction system pathways. They argue that
spreads from the prominence of the right auricle up to torus inter- these preferential pathways mostly consist of working heart muscle
venosus and, in some cases, as far as to the area of sinus coronar- cells that do not constitute a pathway. The pathways in individual
ius. There can be interspecific variations of the localization of the hearts differ in their running, according to the muscle arrangement.
node (20). The node is formed by thin fusiform cells, arranged in They are considered to be muscular atrial bundles – trabeculae
winding shape, with a tendency to a longitudinal arrangement along formed by contractile cardiomyocytes. This opinion is based on the
sulcus terminalis. The cells of the interior layer are circularly definition of a pathway tract (43–44), in the formulation of Aschoff
arranged surrounding the SA artery that runs through the center of 1910 and Mönckeberg 1910.
the node. The sinoatrial node enwrapping the sinoatrial artery 1. Fibers in a pathway tract should be identical.
reminded Söderström (1948) of an enormous adventitia (21). Pace- 2. There should be formed a casing of connective tissue sur-
maker cells of the node – nodal cells, have very little of striated rounding the bundle– features of an isolated cable.
myofibrils, a centrally placed nucleus and a slightly eosinophilic 3. There must be continuity, joining one fiber to another.
cytoplasm. They are smaller than atrial cardiomyocytes - 3–9 The given pathways do not fulfil these conditions. Emberson
microns wide, 15–20 microns long. They are surrounded by a net of with Challice 1970 and Bojsen-Moller with Tranum-Jensen 1972
interstitial tissue containing mostly collagenous fibrils with some described a so-called ”sinoatrial ring node” – SARB. They used
elastic fibers. The number of fibers increases with age. Transitional cholinesterase staining in mammals, such as a rabbit, to find an
cells with more than 50 % of myofibrillar content can be found open ring of atrial cells going through one elliptical branch by the
marginally in the node. They have marked Z, H, M zones and lines cauda of sinuatrial node, along sulcus terminalis and through the
and are bigger than nodal cells, about 10 microns, and have more second branch over the head of sinuatrial node and septum up to the
nexuses (gap junctions) as well. As for their structure, they are atrioventricular node (45, 46). The question is whether this ring
between typical contractile muscle cardiomyocytes with a great partly overlaps with internodal pathways or not.
amount of contractile myofibrils, and nodal cells with a small quan-
tity of myofibrils.
Viewed through a microscope, nodal cells contain a small ATRIOVENTRICULAR BUNDLE (HIS BUNDLE),
amount of irregularly arranged myofibrils and mitochondria. The RIGHT AND LEFT BRANCH
sarcoplasmatic reticulum is ramified but poorly developed. There is
no transversal tubular system. Junctions between the cells are We should be grateful to Tawara (1906) for emphasizing the
formed mostly by desmosomes or by few fasciae adherentes and morphological unit of transfer of the atrioventricular node to the
several nexuses. Intercalary discs cannot be seen. Myofibrils form atrioventricular bundle, branches and Purkinje fibers. The atrioven-
only 40 % of the whole cell volume (22). For basic data about the tricular bundle consists of two parts: a so-called penetrating bundle,
node structure see citations (23–31). going through the fibrous figure, and a ramifying bundle, lying

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astride on the ventricle septum muscle, under the membranous sep- of diameter) and are situated in the ventricular myocardium (32).
tum. The left branch runs from the bundle as a continuous layer of They are also located in the ventricular subendocardial layer and in
fibers along the whole length of bifurcation, whereas the right false chordae tendineae.
branch seems to be a direct follow-up of the ramifying bundle. The Type III. – These are present in the junction between the big
right branch passes under the septal endocardium to the musculus Purkinje cell and the myocardium cell and are bigger than working
papillaris anterior and fragments to the net of Purkinje fibers for the cardiomyocytes. They have few mitochondria and no T system. We
walls of the right ventricle. The left branch splits under the septal call them transitional form of Purkinje cell (8-12 microns of dia-
endocardium into the anterior and posterior fasciculi and both of meter).
them pass to Purkinje fibers of the ventricle. Some authors recog- The size of Purkinje fibers is also given in various forms. There
nize three rather than two fasciculi: anterior, medial and posterior. are interspecific variances, but there are also differences in data
The cells of both parts of the atrioventricular bundle and branches from different authors. The size of Purkinje fibers in whales is about
in human are smaller than the cells of the working myocardium 19–94 microns whereas in humans it is about 10–46 microns (32).
(37). However, in bigger mammals, such as cows and sheep, the Purkinje cells, as is universally accepted, contain few myofibrils.
cells of atrioventricular bundle and branches resemble larger The Z line may be larger but may be absent as well. The T system
Purkinje cells. The cells in the bundle and branches are longitudi- is absent or just poorly developed and mitochondria are small with
nally oriented and separated by collagenous fibers. James and Sherf few cristae. Myofibrils in Purkinje fibers work as passive cytoskele-
(1971) described in electronogrammes in dogs and humans that the tal components (52, 54). They are different in composition of
atrioventricular bundle consists of large cells similar to Purkinje myosin from the cells of working myocardium, as they contain not
fibers, containing few myofibrils and a light perinuclear zone (16). only two light chains but also an accessory type of myosin with an
In addition they found 2 types of transitional cells there: large ones intermediate molecular weight (53, 55). Unlike working cardio-
and narrow ones. In the proximal part of the bundle they described myocytes, where the sarcoplasmatic reticulum is joined with the
the cells identical to the sinuatrial bundle cells. Here, in the SA sarcolemma of the T tubule (interior coupling) and with the periph-
node, they called them P cells. The cells in question are nodal cells eral sarcolemma (peripheral coupling), Purkinje fibers that do not
microscopically appearing as pale. However, cardiologic literature have T tubules are joined with the peripheral sarcolemma only (56).
did not accept this term and consistently continues to use the term Purkinje fibers are PAS positive as they contain a considerable
of “nodal cells” for the SA and AV node cells. They cannot be mis- amount of glycogen, which is typical for the conduction system
taken with Purkinje fibers. Later on, James et al. (1974) described cells (50,49). A large quantity of glycogen in Purkinje fibers is
the ultrastructure of branches (47). According to them, the left metabolized by the way of anaerobic enzymes. Thanks to this pro-
branch consists of typical Purkinje fibers (cells) that are mixed with perty, these cells are more resistant to hypoxia than the ventricle
cells resembling working cardiomyocytes. The cell junctions are myocardium cells (57). An activity of acetylcholinesterase was
made of intercalated disks that contain long nexuses. The right found in the conduction system, including Purkinje cardiomy-
branch is mostly formed by working cardiomyocytes. Typical Pur- ocytes; however, no such activity was detected in working
kinje fibers (cells) were very rare in the right branch. Vassal–Adams myocardium cells (58). There is interspecific variety in connection
(1983) does not recognize these findings and considers the whole of Purkinje fibers with working ventricular cardiomyocytes, among
atrioventricular system, including the node, quite heterogeneous different animals and between animal and man as well. The differ-
(48). It cannot be clearly specified into separated cell types. All ence is in presence or absence of transitional cells between Purkin-
these heterogeneous cells are connected with intercalated disks. je fibers and working cardiomyocytes. Such a connection between
a Purkinje cardiomyocyte and a transitional cell guarantees a high
resistance of coupling and a quick conduction on the working
PURKINJE FIBERS (PURKINJE CELLS, myocardium. This arrangement is well marked in rabbits and pigs
PURKINJE CARDIOMYOCYTES, (59). On the contrary, no transitional cells were detected in human
RAMI SUBENDOCARDIALES and cattle hearts. The Purkinje fibers detected here only got smal-
ler on passage to the myocardium. In the cattle heart, Purkinje fibers
They represent the terminal part of the conduction system. They under the ventricular endocardium form a two-dimensional net that
consist of the AV bundle and branch. Under the ventricle endo- converts into a three-dimensional one on its passage to the
cardium the branches fragment into the net of fibers discovered by myocardium. At the beginning, Purkinje fibers in myocardium are
Purkinje. These are formed by cells with a small amount of fibrils surrounded by a connective tissue - which gradually disappears, so
and a great quantity of glycogen in reverse. Purkinje fibers in that a contact of the Purkinje fibers with ventricular myocytes can
human reach only the interior myocardium layer, whereas in certain be realized. Only in the area of 2 mm under the epicardium was this
animals they extend to the whole myocardium (6, 49). The fibers connection not found (60). This electrical coupling between Pur-
are connected to the working myocardial cells by intercalated disks, kinje fibers and working cardiomyocytes may be disturbed in aci-
with or without the transitional cells. One fiber transfers the dosis, hypoxia and hyperkalemia (61). Ectopic impulses, distur-
impulse on thousands of working cardiomyocytes. This arrange- bances in conduction of an impulse and reentry tachycardias can
ment guarantees a synchronous action of working cardiomyocytes emerge in Purkinje fibers in the peri-infarctuous area (62–64). The
during the contraction. electrical impulse is more quickly transferred by Purkinje fibers
There is no uniform description of Purkinje cells in the literature. (2–3 m/sec) than by ventricular cardiomyocytes (0,3–0,4 m/sec).
Thus, in the paper of Obermeier already, a description of three types That is thanks to a group of proteins – connexins C40,C43, C45. If
of Purkinje cells (see the chapter about history) may be found. the connexins are knockouted, a disturbance appears in conduction
Another description of 3 types of Purkinje cells was given in of impulses through the AV node and Purkinje fibers, including the
1973 and 1987 (50, 51): spatial conduction of impulses (65, 66). A confocal laser micro-
Type I. – The cells of this type are situated in the area of the scope is used in mapping normal and abnormal dynamics of Ca2+ in
atrioventricular bundle bifurcation and in the proximal part of Purkinje conduction cells (67). An accumulation of Ca2+ in the
branches. They contain a small amount of myofibrils and the cells cytosol in the present of cardiotonic agens leads to tachyarrhyth-
are smaller (6 microns of diameter) than in type II. mias in the Purkinje cells but not in the working ventricular car-
Type II. – These are the biggest Purkinje fibers (10–20 microns diomyocytes (68). Lately, the genes influencing the development of

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Picture 1. Conducting system (Purkinje fibres) of the left cardiac ventricle

Picture 2. Electronmicroscopic pictures of the conducting cardiac system.
Photograph of the dissection from the Institute of Anatomy, 1st Medical
A: a nodal cell from the sinuatrial node; B: a nodal cell from the
School, Charles University, kindly allowed by Professor Seichert and
atriventricular node; C – a Purkinje cell (Purkinje fiber); D – a cell from
Doctor Naňka
the sinus coronarius area (a possible ectopic center).
Cells from all parts of the conducting system have a strong resemblance in
the His-Purkinje system and disturbances of the conduction system ultrastructural terms.
cells, have been explored in transgenic animals – expression of the
lacZ gene (69, 70). The His – Purkinje system starts working as
soon as before the septation of the heart. by a pathological event such as myocardial infarction. Embryologic
research shows that some primordial areas in the heart convert to the
postnatal conduction system. Discovery of the genes and their local-
SUBSIDIARY PACEMAKER CENTRES – ization in the developing heart invokes the following issue: would
ECTOPIC CENTRES they be effective in distinguishing and accurately topographically
determining the conduction system? It is debatable whether the areas
From the electrophysiological point of view, numerous authors differentiable by the way of transgenes, such as minK-LacZ or
have convincingly demonstrated that in the heart there are centers Engrailed2-LacZ, which is also known as CCS-LacZ, can be con-
of formation of subsidiary and ectopic rhythms. These were sidered part of the conduction system. It is questionable, since these
described in the area of coronarysinus on the false chordae areas are significantly larger than the components defined and veri-
tendineae and in ventricles, by the ramification of Purkinje fibers, fied to be part of the conduction system. Another arguable issue is
on sleeves of pulmonary veins or in the ring surrounding the tricus- whether some acetylcholinesterase positive cells, at certain places
pid or mitral valve (71–74). Recently, ectopic impulses registered (such as retroaortally or in the tricuspid valve), can be considered
from the pulmonary veins have been closely studied as well (75, conductive or whether they have just a nodal phenotype – they do
76). In this content, Professor Šteiner (77) has lately pointed out the not work as postnatal conduction system. During the embryonic
Purkinje’s and his student’s Raeuschel’s priority in describing stage in the primitive heart, in the shape of a simple tube, its every
myocardial fibers on pulmonary veins. However, it is very difficult cell is endowed with rhythmicity. However, only a part of them
from the morphological point of view to identify these centers. For become cells of the conduction system. There are also interspecific
now, only a description of the myocardial muscle arrangement on problems, as the conduction system is more distinctly modeled in
pulmonary veins is known (78, 75). Only some individual cells with mammals in comparison to lower classes of vertebrates. There is
a morphological resemblance to conduction cells have been found a whole range of questions to be answered. From these several com-
so far, e.g. in the area of sinus coronarius (79, 80). ments it is clear that research into the conduction system will pro-
Although some controversial contentions exist, from the given ceed. Genetic therapy of disturbances of the conduction system will
overview is clear that Purkinje fibers are morphologically very definitely be one of the future ways. Cell therapy, whether it is by
similar to the cells of other parts of the conduction system. The means of embryonic stem cells or adult mesenchymal cells, is
main list of identical features is given in the summary. promising. Biological pacemakers, created in these ways could
Considering all the facts given in this paper, the frontier between replace contemporary electric pacemakers (71).
the normal myocardium and the conduction system (specialized
myocardium) seems to be clearly apparent. Nevertheless, Anderson
and his colleagues (42) recently published controversial opinions on P.S.
the anatomical definition of conduction systems. He gives the fol-
lowing opinion presented at the Novartis symposium 2002 about the When studying historic materials I was surprised and puzzled
conduction system: not only are all myocardial cells in the postnatal after having read the sentence by Professor Chodounský (5),
heart able to transfer the impulse, but in addition all of them have a assistant of Purkinje’s, in his memoir book ”Jan Evangelista Purk-
a potential of being congenitally special as for the conduction sys- inje, his Impact on the Czech Culture “ from 1927. When describ-
tem. Even the myocardium, described as “working”, is significantly ing Purkinje’s funeral he wrote on page 110:
heterogeneous, considering its morphology, ultrastructure and It has to be remarked that Professor Treitz was the one and only
genes. Nevertheless, the incontestable fact is that some cells are faculty member of the Prague Medical School who came to the
more specialized than others and form a conduction system. That is churchyard of Vyšehrad
not just an academic question, as fatal arrhythmias may occur in the It would be unworthy of the Alma Mater not to pay its respects
event of disturbances of the system caused either by physiologists or to this genius.

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