Morphological and histological investigation of the conduction system in the equine atrial muscle sleeve of pulmonary veins.

ABSTRACT

BACKGROUND: Atrial fibrillation is the most common arrhythmia in horses causing poor performance. The role of pulmonary vein triggers in the pathogenesis has been identified in horses. Ablation methods have been investigated, but the available information on anatomical, histological and immunohistochemical assessment of the pulmonary vein ostia and the conduction system of the myocardial sleeve is still limited. OBJECTIVES: The aim of the study was to describe the morphological properties of the myocardial sleeve in healthy horses. STUDY DESIGN: Cross-sectional. METHODS: Eighty-three equine hearts were dissected. The number and diameters of pulmonary vein ostia were determined, and anatomical localisation was described. Fifty-eight tissue samples were collected for routine histology and 12 of these were used for immunohistochemistry (connexin 43, 45, S100, and tyrosine hydroxylase antibodies). RESULTS: The mean number of pulmonary vein ostia was 4.5 (4 veins 46 horse, 5 veins 31 horses, 6 veins 6 horses). Diameters (mean ± SD) of the main ostia were as follows vein I 20.2 ± 7.0 mm, vein II 32.7 ± 7.1 mm, vein III 33.4 ± 5.9 mm, vein IV 18.1 ± 4.5 mm. Diameters of supernumerary vein ostia varied between 3.0 and 28.0 mm (11.5 ± 5.5 mm). Early branching was found in 26 horses (31.3%) and 30 veins (vein I 14, vein II 9, vein III 5, vein IV 2). Histology confirmed the presence of a muscle sleeve composed of myocardial tissue in each pulmonary vein. S100 and TH positivity was detected in each vein, and it confirmed the presence of adrenergic and non-adrenergic nerve fibres within the myocardial sleeve. Cx43 and 45 positivity were also found in each vein indicating the presence of gap junctions. MAIN LIMITATIONS: The effect of bodyweight on pulmonary vein dimensions is unknown. CONCLUSIONS: Future ablation techniques should consider that conductive tissue is present in the entire myocardial sleeve in all pulmonary vein ostia.