Normal atrial and ventricular myocardial structures
The heart functions by means of a three-dimensional arrangement of myofibres supported by an extracellular matrix which plays an important role in maintaining the size and shape of the heart. In both atria, the structure of the walls and the atrial septum confers a three-dimensional arrangement of muscle bundles and myoarchitecture that allows preferential electrical intra- and interatrial conduction which is important for a better understanding of atrial activation and arrhythmias. The myoarchitecture within the ventricular walls has a three-dimensional arrangement of myofibres, within a supporting matrix of fibrous tissue, which changes orientation from being oblique in the subepicardium to circumferential in the middle and to longitudinal in the subendocardium, allowing the chambers to change in shape and size through the cardiac cycle. Within each ventricle, the circumferential portion is the thickest transmurally, with the longitudinal portion the thinnest. The three-dimensional arrangement of the ventricular mesh serves to realign the myocytes during ventricular contraction, accounting for the extent of systolic mural thickening. Abnormal myoarchitecture in combination with alterations in the connective tissue matrix provide the structural basis for abnormalities in myocardial function.