A New Dimension in Cardiac Imaging: 3D Exploration of the Atrioventricular Conduction Axis with Hierarchical Phase-contrast Tomography

Much of our understanding of the atrioventricular conduction axis has been derived from early 20th-century histological investigations. These studies, while foundational, are constrained by their two-dimensional representation of complex, three-dimensional anatomy. The variability in the course of the atrioventricular conduction axis, and its relationship to surrounding cardiac structures, necessitates a more advanced imaging approach. Utilizing hierarchical phase-contrast tomography (HiP-CT) of an autopsied heart specimen with cellular resolution, this review provides a contemporary understanding of the atrioventricular conduction axis. By correlating these findings with three-dimensional computed tomographic reconstructions in living patients, we offer clinicians the insights needed accurately to predict the location of the atrioventricular conduction axis. This novel approach overcomes the inherent limitations of two-dimensional histology, enhancing our ability to understand and visualize the intricate relationships of the conduction axis within the heart.