Quantitative Head-to-Tail Analysis Reveals Heterogeneous Cellular Organization and Connexin Expression in the Porcine Sinoatrial Node

Background: The sinoatrial node (SAN) is an integral component of the cardiac conduction system that dictates heart rhythm. Optical mapping studies have demonstrated functional differences between the superior and inferior leading pacemaking sites in the human SAN; however, the mechanistic connections between structure and function in the SAN through intra-tissue and inter-tissue current source-sink relationships have not been fully resolved. Methods: Porcine SAN longitudinal cryosections along the head-to-tail axis were immunostained and analyzed for regional cell organization and connexin (CX) isoform expression. Results: Quantification of pacemaking cardiomyocyte (PCM) density revealed >9-fold more PCMs within a SAN volume than suggested by a widely cited estimate, assuming comparable PCM densities across species. The SAN head region consisted of large PCM clusters with low aspect ratios, high PCM density, low fibroblast density, and PCMs with the highest HCN4 expression and lowest CX40 and CX43 expression. These characteristics are consistent with an electrically well-insulated, strong current-source that supports pacemaking function. Although the SAN tail also exhibited high local PCM density, its smaller PCM clusters, lower HCN4 expression, and higher CX40, CX43, and CX45 expression rendered it a weaker current source. The SAN mid-region exhibited large PCM clusters aligned in the head-to-tail axis and the highest expression of CX40 and CX45, an expression profile that suggests a fast-conducting intra-tissue pathway that electrically links the leading pacemaking sites at the head and tail. The peripheral SAN at the head and tail also exhibited higher CX expression of all isoforms than the central subregions, an organization consistent with enhanced inter-tissue coupling required for proper pacing function. Conclusions: Our data provide novel insights into the distinct regional micro-organization of the SAN along the head-to-tail axis, which through intra-tissue and inter-tissue coupling, likely modulates the balance of current source-sink relationships that supports robust pacemaking and pacing functions.