Localization of the components of the cardiac conduction system (CCS) is essential for many therapeutic procedures in cardiac surgery and interventional cardiology. While histological studies provided fundamental insights into CCS localization, this information is incomplete and difficult to translate to aid in intraprocedural localization. To advance our understanding of CCS localization, we set out to establish a framework for quantifying nodal region morphology. Using this framework, we quantitatively analyzed the sinoatrial node (SAN) and atrioventricular node (AVN) in ovine with menstrual age ranging from 4.4 to 58.3 months. In particular, we studied the SAN and AVN in relation to the epicardial and endocardial surfaces, respectively. Using anatomical landmarks, we excised the nodes and adjacent tissues, sectioned those at a thickness of 4 µm at 100 µm intervals, and applied Masson’s trichrome stain to the sections. These sections were then imaged, segmented to identify nodal tissue, and analyzed to quantify nodal depth and superficial tissue composition. The minimal SAN depth ranged between 20 and 926 µm. AVN minimal depth ranged between 59 and 1192 µm in the AVN extension region, 49 and 980 µm for the compact node, and 148 and 888 µm for the transition to His Bundle region. Using a logarithmic regression model, we found that minimal depth increased logarithmically with age for the AVN (R2=0.818, P=0.002). Also, the myocardial overlay of the AVN was heterogeneous within different regions and decreased with increasing age. Age associated alterations of SAN minimal depth were insignificant. Our study presents examples of characteristic tissue patterns superficial to the AVN and within the SAN. We suggest that the presented framework provides quantitative information for CCS localization. Our studies indicate that procedural methods and localization approaches in regions near the AVN should account for the age of patients in cardiac surgery and interventional cardiology.
Light-scattering spectroscopy (LSS) is an established optical approach for nondestructive characterization of biological tissues. Here, we investigated the capabilities of LSS and convolutional neural networks (CNNs) to quantitatively characterize the composition and arrangement of cardiac tissues. We assembled tissue constructs from 200 μm thick sections of fixed myocardium and aortic wall. Thickness of the tissue constructs was similar to the thickness of atrial free wall. In the assembled constructs, the aortic sections represented fibrotic tissue and the depth, volume fraction, and arrangement of these fibrotic insets were varied. We gathered spectra with wavelengths from 500-1100 nm from the constructs at multiple locations relative to a light source. We used single and combinations of two spectra for training of CNNs. With independently measured spectra, we assessed the accuracy of the trained CNNs for classification of tissue constructs from single spectra and combined spectra. In general, classification accuracy with single spectra was smaller than with combined spectra. Combined spectra including spectra from fibers distal from the illumination fiber typically yielded a higher accuracy than proximal single collection fibers. Maximal classification accuracy of depth detection, volume fraction and permutated arrangements was (mean±stddev) 88.97±2.49%, 76.33±1.51% and 84.25±1.88%, respectively. Our studies demonstrate the reliability of quantitative characterization of tissue composition and arrangements using a combination of LSS and CNNs. Potential clinical applications of the developed approach include intraoperative quantification and mapping of atrial fibrosis as well as assessment of ablation lesions.