Arrhythmias & electrophysiologyMechanistic study

Unraveling the enigmatic morphology of the atrioventricular conduction axis using hierarchical phase-contrast tomography

Heart RhythmPublished

  • Hierarchical phase-contrast tomography (HiP-CT) imaging study of adult human hearts

Authors' conclusion

HiP-CT provides high-resolution 3D visualization of the AV conduction axis in adult hearts, revealing its morphology and variability. These findings offer new insights into structure-function correlations relevant to clinical electrophysiology and interventional procedures.

Study context

Population
Adult human hearts (mean donor age 81.6 years) imaged at the European Synchrotron Radiation Facility
Participants
5 adult human hearts

Main finding

As reported in the abstract

Nonbranching bundle length

Range

2.49 to 8.80 mm

Mean

6.31 mm

Further findings

Branching pattern

In all hearts, the axis branched first into a broad left bundle, followed by a cord-like right bundle branch

Additional superior septal pathways

Hearts with additional superior septal pathways
4

Cardiomyocyte alignment

Transition from interwoven cardiomyocytes in the node to parallel alignment in the insulated nonbranching bundle

Anatomic landmark

A line from the anteroseptal commissure of the tricuspid valve to the medial papillary muscle reliably located the nonbranching bundle

Original publication

Unraveling the enigmatic morphology of the atrioventricular conduction axis using hierarchical phase-contrast tomography. Heart Rhythm. Published 17 July 2026. doi:10.1016/j.hrthm.2026.07.018

Summarised from the published abstract; every number is checked against it