A new dimension in cardiac imaging: Three-dimensional 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 histologic investigations. These studies, although foundational, are constrained by their 2-dimensional representation of complex 3-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. Using hierarchical phase-contrast tomography of an autopsied heart specimen with cellular resolution, this review provides a contemporary understanding of the atrioventricular conduction axis. By correlating these findings with 3-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 2-dimensional histology, enhancing our ability to understand and visualize the intricate relationships of the conduction axis within the heart. [Display omitted]