[A histopathological study on the cardiac conduction system in sudden death of unknown origin]

Abstract

For the purpose of searching for the underlying mechanism of sudden death, 46 cases of non-traumatic sudden death were selected from autopsied cases during the past 8 years from 1980 to 1987 in the department of legal medicine, St. Marianna university school of medicine. These included 40 males and 6 females ranging from 30 to 60 years of age. Autopsy revealed the existence of cardiac abnormalities in 41 cases (89.1%). Among them, acute myocardial infarction was found in 23 cases (56.1%) and there were 16 cases (39.0%) diagnosed as acute cardiac failure because of the absence of organic abnormality in the heart. Out of the latter cases having undefined etiology of sudden death, 10 cases were selected and histopathological study on the cardiac conduction system was performed by Lev's method. Fatty infiltration in the sinus node, in the atrio-ventricular node and bundle of His was observed in 5 cases, severe stenosis of atrio-ventricular nodal artery in 2 cases and subendocardial hemorrhage of left bundle branch in 1 case. In the remaining case, no pathological abnormality was observed. These results suggest that the organic lesion of the cardiac conduction system could underlies the clinically undefined cause of sudden death.