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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.

StatPearls [Internet].

Show detailsTreasure Island (FL): StatPearls Publishing; 2025 Jan-.Search term Atrioventricular Node

Joseph Heaton; Amandeep Goyal.

Author Information and Affiliations

Authors

Joseph Heaton1; Amandeep Goyal2.

Affiliations

1 Jersey Shore University Medical Center2 University of Kansas Medical Center

Last Update: July 25, 2023.

Definition/Introduction

The atrioventricular (AV) node is a small structure in the heart, located in the Koch triangle,[1] near the coronary sinus on the interatrial septum. In a right-dominant heart, the atrioventricular node is supplied by the right coronary artery. The purpose of this structure is to connect the electrical systems of the atria and the ventricles, providing electrical impedance from the atria and an intrinsic pacemaker in its absence. The intrinsic rate of the AV node is 40 to 60 beats per minute (bpm).

Issues of Concern

AV Block

The AV node can hinder electrical conduction, causing a pathologic state. In heart block, a 2-degree heart block is specifically related to the AV node.[2] The first type, Mobitz I or Wenckebach heart block, is when the AV node becomes increasingly refractory to impulses, resulting in a dropped beat.[3] This phenomenon is preceded by increasing PR intervals, giving a characteristic electrocardiogram (EKG) finding.

Though similar by name, the cause of Mobitz I is distinctly different from Mobitz II. In Mobitz II, a lesion within the His-Purkinje system causes dropped beats.[4] The EKG finding is distinct through the presentation of dropped beats without an increasing PR interval. This rhythm can easily lead to a complete heart block. 

Cystic Tumor of the Atrioventricular Nodal Region (CTAVN)

Primary tumors of the cardiac system are rare. Cystic tumors of the AV nodal region (CTAVN) is an example for which only about 70 cases have been identified.[5] The tumor grows at the base of the interatrial septum and can disrupt the electrical conduction pathway, leading to sudden cardiac death.[6] Terminal events may be preceded by syncopal episodes and identified as heart block on an EKG.

Clinical Significance

Understanding the anatomy and function of the AV node is crucial for understanding pathologic conditions that may present in the clinical setting.

Junctional Escape Beat

A junctional escape beat originates in the AV node when impulses from pacemakers upstream are not enough to overtake the AV node's intrinsic activity. Due to this bradycardia, an ectopic beat is generated in the AV node, which then conducts downstream along the normal pathway, causing synchronized ventricular depolarization. This condition can be provoked due to excessive vagal tone, pathologies associated with the SA node, or in the setting of heart block. Classic EKG findings include pulse rates of 40 to 60 bpm, regular rhythm, and a narrow QRS complex. Additionally, inverted P-waves may be present, though they can be hidden within the QRS complex. This is due to retrograde conduction to the atria from the AV node generated impulse.

Accelerated Junctional Rhythm and Junctional Tachycardia

Accelerated junctional rhythm and junctional tachycardia are two forms of an accelerated rhythm originating from the AV node. In accelerated junctional rhythm, a pathologic AV node generates an electrical impulse at a rate of 60 to 100 bpm; in junctional tachycardia, the accelerate rate is higher than 100 bpm.[7] In both cases, the AV node becomes a generator of ventricular depolarization, providing a narrow QRS complex, and a regular rhythm on EKG. In the setting of heart block, accelerated AV nodal rhythms may be concurrent with other forms of supraventricular tachycardia (SVT).

Atrioventricular Nodal Reentry Tachycardia (AVNRT)

In or near the AV node, fast and slow pathways conduct electrical activity similar to a healthy AV node. In typical AVNRT, the P wave is conducted through the fast pathway, anterograde towards the ventricles; the signal is then conducted through the slow pathway, retrograde back to the atria. This can be seen on EKG as a P wave after the QRS complex. Multiple atypical AVNRT variations exist, depending on the pathway configurations. Ablation therapy may resolve AVNRT.[8]

Junctional Ectopic Tachycardia (JET)

Junctional ectopic tachycardia is a rare condition typically seen in newborns and post-cardiac surgery.[9][10] In JET, there is a short circuit through the AV node, which bypasses the normal gatekeeper function. Consequently, impulses generated by the atria can be conducted to the ventricles without impedance, up to a 1 to 1 ratio. JET can be distinguished from AVNRT using adenosine; in JET, the tachycardia will continue without AV dissociation; however, in AVNRT, adenosine should terminate the arrhythmia.

Wolff–Parkinson–White Syndrome (WPW)

Wolff–Parkinson–White syndrome is a pathologic state of cardiac electrical conducting system, insomuch as it averts the AV node. An accessory or extra pathway, known as the Bundle of Kent, allows impulses from the sinoatrial (SA) node to bypass the AV node and cause excitation of the ventricles.[11] Without the gatekeeping function of the AV node, the ventricles can conduct up to the rate of the atrium, which is particularly dangerous in SVTs. Wolff–Parkinson–White syndrome can be differentiated from AVNRT and JET as the accessory pathway is outside of the AV node. On EKG, WPW can be identified through the characteristic delta wave.[12]

Atrioventricular Reentry Tachycardia (AVRT)

ANRT may occur only when an accessory bundle is present. In typical AVRT, the impulse conducts through the normal pathway, from the sinoatrial node to the bundle branches; instead of the impulse terminating at the bundle branches, it conducts through the accessory pathway towards the AV node. When the original impulse arrives at the AV node, it reenters the normal conduction pathway, forming a loop and causing additional action potentials. This condition is differentiated from AVNRT by the conduction path. In AVRT, the conduction travels through the bundle branches and reenters the AV node through an accessory pathway. In AVNRT, the loop is contained within the AV node and does not require an accessory pathway outside the AV node. Attached media provides a visual representation. 

Nursing, Allied Health, and Interprofessional Team Interventions

Identification of an AV nodal pathology is crucial to the diagnosis and management of potentially fatal syndrome from nonspecific symptoms. Often the presentation of these potentially fatal syndromes is with apparently benign symptoms such as palpitations. In some cases, patients may present with syncope as well. However, upon evaluation, the EKG may only have subtle signs of disease which require astute observation and a high index of suspicion. Thus, an interprofessional team, including physicians, electrophysiological, and telemetry trained nurses, are required in the care of these patients. Each member of the interprofessional team plays an important role in diagnosing these patients in a timely manner. When clinical suspicion is high, cardiac specialists should be consulted for evaluation and consideration of diagnostic or therapeutic procedures. A collaborative interprofessional team can greatly improve outcomes in patients with AV nodal disease and arrhythmias. 

Review Questions

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Figure

Heart, cardiac anatomy, atrioventricular AV node Contributed by the Royal College of Anaesthetists (RCoA) and Association of Anaesthetists of Great Britain and Ireland (AAGBI)

Figure

SVT overview Contributed by Jonas de Jong, MD

References

1.Kurian T, Ambrosi C, Hucker W, Fedorov VV, Efimov IR. Anatomy and electrophysiology of the human AV node. Pacing Clin Electrophysiol. 2010 Jun 01;33(6):754-62. [PMC free article: PMC2889145] [PubMed: 20180918]2.Scheinman MM. Atrioventricular nodal conduction and refractoriness. Pacing Clin Electrophysiol. 1993 Mar;16(3 Pt 2):592-8. [PubMed: 7681963]3.Roberts NK, Cabeen WR. Atrioventricular nodal function in progressive systemic sclerosis: electrophysiological and morphological findings. Br Heart J. 1980 Nov;44(5):529-33. [PMC free article: PMC482440] [PubMed: 7437193]4.Benson DW. Genetics of atrioventricular conduction disease in humans. Anat Rec A Discov Mol Cell Evol Biol. 2004 Oct;280(2):934-9. [PubMed: 15372490]5.Sharma G, Linden MD, Schultz DS, Inamdar KV. Cystic tumor of the atrioventricular node: an unexpected finding in an explanted heart. Cardiovasc Pathol. 2010 May-Jun;19(3):e75-8. [PubMed: 19144541]6.Suzuki K, Matsushita S, Suzuki H, Kuroda K, Inaba H, Arakawa A, Hayashi T, Amano A, Kuwatsuru R. Cystic tumor of the atrioventricular node: computed tomography and magnetic resonance imaging findings. J Thorac Imaging. 2014 Nov;29(6):W97-9. [PubMed: 25303965]7.Hafeez Y, Grossman SA. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Feb 5, 2023. Junctional Rhythm. [PubMed: 29939537]8.Lee PC, Chen SA, Hwang B. Atrioventricular node anatomy and physiology: implications for ablation of atrioventricular nodal reentrant tachycardia. Curr Opin Cardiol. 2009 Mar;24(2):105-12. [PubMed: 19225293]9.Kylat RI, Samson RA. Junctional ectopic tachycardia in infants and children. J Arrhythm. 2020 Feb;36(1):59-66. [PMC free article: PMC7011855] [PubMed: 32071621]10.Catton KG, Peterson JK. Junctional Ectopic Tachycardia: Recognition and Modern Management Strategies. Crit Care Nurse. 2020 Feb 01;40(1):46-55. [PubMed: 32006036]11.Chhabra L, Goyal A, Benham MD. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Aug 7, 2023. Wolff-Parkinson-White Syndrome. [PubMed: 32119324]12.Kesler K, Lahham S. Tachyarrhythmia in Wolff-Parkinson-White Syndrome. West J Emerg Med. 2016 Jul;17(4):469-70. [PMC free article: PMC4944806] [PubMed: 27429700]

Disclosure: Joseph Heaton declares no relevant financial relationships with ineligible companies.

Disclosure: Amandeep Goyal declares no relevant financial relationships with ineligible companies.

Copyright © 2025, StatPearls Publishing LLC.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

Bookshelf ID: NBK557664PMID: 32491596 Share

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• Cite this PageHeaton J, Goyal A. Atrioventricular Node. [Updated 2023 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.

In this Page

• Definition/Introduction
• Issues of Concern
• Clinical Significance
• Nursing, Allied Health, and Interprofessional Team Interventions
• Review Questions
• References

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• PMCPubMed Central citations
• PubMedLinks to PubMed

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