Pacemaker and conduction system myocytes play crucial roles in initiating and regulating the contraction of the cardiac chambers. Genetic defects, acquired diseases, and aging cause dysfunction of the pacemaker and conduction tissues, emphasizing the clinical necessity to understand the molecular and cellular mechanisms of their development and homeostasis. Although all cardiac myocytes of the developing heart initially possess pacemaker properties, the majority differentiates into working myocardium. Only small populations of embryonic myocytes will form the sinus node and the atrioventricular node and bundle. Recent efforts have revealed that the development of these nodal regions is achieved by highly localized suppression of working muscle differentiation, and have identified transcriptional repressors that mediate this process. This review will summarize and reflect new experimental findings on the cellular origin and the molecular control of differentiation and morphogenesis of the pacemaker tissues of the heart. It will also shed light on the etiology of inborn and acquired errors of nodal tissues. (Circ Res. 2010;106:240-254.)Key Words: conduction system Ⅲ pacemaker Ⅲ sinus venosus Ⅲ atrioventricular canal Ⅲ development T he contractions of the heart are initiated and coordinated by electric signals from pacemaker tissues. At the entrance of the right atrium, sinus node (sinoatrial node [SAN]) myocytes generate the impulse to activate the atrial myocardium. After rapid propagation through the atria, the impulse is delayed in the atrioventricular node (AVN) and further propagated to the fast-conducting atrioventricular bundle (AVB), bundle branches (BB), and Purkinje fiber network, from which the mass of the ventricular working myocardium is activated. The components of the conduction system contain cardiomyocytes with pacemaker activity and other specific nodal properties that discriminate them from atrial and ventricular working myocardium (Figure 1). The SAN serves as the primary pacemaker, whereas the AVN and ventricular conduction system act as secondary (accessory) pacemakers to secure Original