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Cohle SD, Wygant CM. Lesions of the Cardiac Conduction System and Sudden Death. Am J Forensic Med Pathol 2024; 45:3-9. [PMID: 37994486 DOI: 10.1097/paf.0000000000000895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
ABSTRACT When a young previously healthy person dies suddenly, occasionally, the scene is noncontributory and the autopsy and drug screen are negative. In such cases, additional studies, including genetic assessment and cardiac conduction system examination, should be performed. We performed a literature search and reviewed our own material to identify possible or definite conduction system anomalies that may cause death. We identified intrinsic conduction system disease including cystic tumor of the atrioventricular node, atrioventricular node (cystic tumor of the AV node), and fibromuscular dysplasia of the atrioventricular node artery to be likely causes of death. Extrinsic causes, in which a generalized disease affects the conduction system, include tumors, autoimmune disease, infiltrative disorders, and others, are a second category of diseases that can affect the conduction system and cause atrioventricular block and sudden death.
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Affiliation(s)
- Stephen D Cohle
- From the Department of Pathology and Laboratory Medicine, Corewell Health, Grand Rapids, MI
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Syncope: Primary Care Office Evaluation and Workup. PHYSICIAN ASSISTANT CLINICS 2017. [DOI: 10.1016/j.cpha.2017.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Masarone D, Limongelli G, Rubino M, Valente F, Vastarella R, Ammendola E, Gravino R, Verrengia M, Salerno G, Pacileo G. Management of Arrhythmias in Heart Failure. J Cardiovasc Dev Dis 2017; 4:E3. [PMID: 29367535 PMCID: PMC5715690 DOI: 10.3390/jcdd4010003] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 02/03/2017] [Accepted: 02/22/2017] [Indexed: 12/14/2022] Open
Abstract
Heart failure patients are predisposed to develop arrhythmias. Supraventricular arrhythmias can exacerbate the heart failure symptoms by decreasing the effective cardiac output and their control require pharmacological, electrical, or catheter-based intervention. In the setting of atrial flutter or atrial fibrillation, anticoagulation becomes paramount to prevent systemic or cerebral embolism. Patients with heart failure are also prone to develop ventricular arrhythmias that can present a challenge to the managing clinician. The management strategy depends on the type of arrhythmia, the underlying structural heart disease, the severity of heart failure, and the range from optimization of heart failure therapy to catheter ablation. Patients with heart failure, irrespective of ejection fraction are at high risk for developing sudden cardiac death, however risk stratification is a clinical challenge and requires a multiparametric evaluation for identification of patients who should undergo implantation of a cardioverter defibrillator. Finally, patients with heart failure can also develop symptomatic bradycardia, caused by sinus node dysfunction or atrio-ventricular block. The treatment of bradycardia in these patients with pacing is usually straightforward but needs some specific issue.
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Affiliation(s)
- Daniele Masarone
- Cardiologia SUN-Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, via L. Bianchi, Naples 80100, Italy.
| | - Giuseppe Limongelli
- Cardiologia SUN-Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, via L. Bianchi, Naples 80100, Italy.
| | - Marta Rubino
- Cardiologia SUN-Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, via L. Bianchi, Naples 80100, Italy.
| | - Fabio Valente
- Cardiologia SUN-Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, via L. Bianchi, Naples 80100, Italy.
| | - Rossella Vastarella
- Cardiologia SUN-Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, via L. Bianchi, Naples 80100, Italy.
| | - Ernesto Ammendola
- Cardiologia SUN-Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, via L. Bianchi, Naples 80100, Italy.
| | - Rita Gravino
- Cardiologia SUN-Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, via L. Bianchi, Naples 80100, Italy.
| | - Marina Verrengia
- Cardiologia SUN-Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, via L. Bianchi, Naples 80100, Italy.
| | - Gemma Salerno
- Cardiologia SUN-Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, via L. Bianchi, Naples 80100, Italy.
| | - Giuseppe Pacileo
- Cardiologia SUN-Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, via L. Bianchi, Naples 80100, Italy.
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