Aquilino Hurlé, MD, PhD, Damián Sánchez-Quintana, MD, PhD, Siew Y

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Capillary Supply to the Sinus Node in Subjects with Long-Term Atrial Fibrillation Aquilino Hurlé, MD, PhD, Damián Sánchez-Quintana, MD, PhD, Siew Y. Ho, MD, PhD, Eduardo Bernabeu, MD, Margarita Murillo, BS, Vicente Climent, MD, PhD The Annals of Thoracic Surgery Volume 89, Issue 1, Pages 38-43 (January 2010) DOI: 10.1016/j.athoracsur.2009.10.008 Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Sinus node histologic sections. (A) and (B) Masson's trichrome staining. (C) and (D) CD 31 endothelial antigen immunohistochemical staining (vessel walls stained in brown). (A) and (C) are specimens from control group and (B) and (D) from atrial fibrillation (AF) group. Note fewer and thinner capillaries in AF specimens; scale bar 15 μm. (CV = capillary vessels.) The Annals of Thoracic Surgery 2010 89, 38-43DOI: (10.1016/j.athoracsur.2009.10.008) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Sinus node transmission electron microscopy images illustrating the main differences between atrial fibrillation (AF) and normal control nodal tissue. (A), (B), and (C) Control specimens. (D), (E), and (F) The AF specimens. All three types of myocardial cells are demonstrated in (A) and (D): nodal cells (Nc), working myocytes (Wm), and transitional cells (Tc). The inset in (A) shows simple cellular boundaries between two nodal and transitional cells. The inset in (D) shows invaginated plasma membranes forming many pinocytic vesicles (arrows) in a nodal cell. (E) shows the altered cell adhesion zone with a disrupted intercalated disk (Id) between two adjacent myocytes (My) and (F) shows mitochondrial disruption. Scale bars: 1 μm for (A) and (D) and 500 nanometers for (B), (C), (E), and (F). (Mi = mitochondria.) The Annals of Thoracic Surgery 2010 89, 38-43DOI: (10.1016/j.athoracsur.2009.10.008) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Transmission electron microscopy micrographs of four vessels. (A) Control group. (B), (C), and (D) Atrial fibrillation group. The vessels shown in (A), (C), and (D) are continuous capillaries. Note large pinocytotic vesicles (Pv) in the endothelial layer (El) of capillary (A), which is magnified in the inset. (B) Precapillary sphincter-metaarteriole with a disrupted smooth muscle layer (Ml), a thick layer of elastic fibers (Ef), and interrupted myoendothelial bridges (arrows). Note the large nuclei (N) protruding into the lumen (L) of the vessel. There is a small thrombus (T) in (C). The outer contour in this capillary vessel shows images corresponding, probably, to fragments of a neighboring pericyte (Pr). (D) Thickened basement membrane (Bm) in continuity to collagen fibers (Co). Scale bar = 1 μm. (Er = erythrocytes.) The Annals of Thoracic Surgery 2010 89, 38-43DOI: (10.1016/j.athoracsur.2009.10.008) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions