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Conduction system in a trained jogger with sudden death.
S Bharati1, L S Dreifus, E Chopskie
1Department of Pathology, Deborah Heart and Lung Center, Browns Mills, NJ 08015-1799.
Chest
|February 1, 1988
Summary
Sudden cardiac death in a trained jogger was linked to an unusual atrioventricular node position and degeneration. This case highlights potential risks of congenital conduction system abnormalities, even in healthy individuals.
Area of Science:
- Cardiovascular Pathology
- Electrophysiology
- Sudden Cardiac Death Etiology
Background:
- A 47-year-old asymptomatic trained jogger with a history of sinus bradycardia and atrioventricular block (AVB) died suddenly.
- The patient had a permanent pacemaker implanted and maintained an active lifestyle until death.
Observation:
- Autopsy revealed an atrioventricular (AV) node abnormally positioned leftward on the atrial septum.
- The AV node exhibited fatty infiltration, fibrosis, and disarray at the nodal-His bundle junction.
- The right bundle branch showed intramyocardial fibrosis, and the left septum had aging changes and arteriolosclerosis.
Findings:
- This is the first reported case of a leftward-displaced AV node with fatty separation from the atria and nodal-His bundle disarray.
- Histopathological findings suggest a congenital abnormality of the cardiac conduction system.
- Degenerative changes in the conduction system likely contributed to the fatal event.
Implications:
- Congenital conduction system abnormalities can remain asymptomatic for years.
- Individuals with such abnormalities may be susceptible to sudden cardiac death.
- This case underscores the importance of considering subtle congenital anomalies in unexplained sudden deaths.