A method of study of the pathology of the conduction system for electrocardiographic and His bundle electrogram...

There have been advances in electrophysiology which have necessitated a more thorough semi-quantitative analysis of the entire conduction system to yield data useful for correlation purposes. Thus an attempt is made to modify and expand our previous method of studying in conduction system pathologically. This method thus includes the study of the sinoatrial (SA) node and its approaches, the atrial preferential pathways, the approaches to the atrioventricular (AV) node, the AV node, the penetrating and branching portions of the AV bundle, the bundle branches, the peripheral Purkinje nets, and the remainder of the atrial and ventricular myocardium. The SA node and its approaches are studied in a longitudinal manner. This gives a better insight into the pathologic changes than does a study in the transverse direction. The approaches to the AV node, bundle and bundle branches are studied in an oblique manner, rather than horizontally apicalward, or from the posterior to the anterior septal region. The horizontal manner does not give sufficient sampling of the AV node and bundle unless complete serial sections are made. Sectioning from the posterior to the anterior septal wall makes difficult an evaluation of the right bundle branch. In conduction system correlation with Wolff-Parkinson-White and Lown-Ganong-Levine syndromes complete serial sectioning of both AV rims is advisable. Where complete serial sectioning is impossible in large adult hearts, retaining every fifth section may be permissible. In the study of congenitally abnormal hearts, it is advisable to embed the entire heart as a unit. If that is impossible because of the size of the heart, then very careful judicious planning of the fashioning of the blocks is necessary, so that displaced SA nodes, and anterior AV nodes and bundles are not overlooked.