Conduction System Studies
JAM COll CARDIOl 879 19R3.1(3) R79-R6 PATHOLOGIC STUDIES Sudden Death in Three Teenagers: Conduction System Studies SAROJA BHARATI, MD, FACC, ROBERT BAUERNFEIND, MD, FACC. LYNN B. MILLER, MD, FACC, BORIS STRASBERG, MD, FACC, MAURICE LEV, MD, FACC Chicago. Illinois The pathologicsubstratefor sudden death in the middle•tient 3 (age 19, feinale) died suddenly at home. Autopsy aged or elderlyad!11tis usually ischemicheartdisease. revealedmitralvalve prolapse, thrombosis of the sino• In contrast,few dataare availableregardingthe pa• atrial(SA) nodeartery,andprematureaging, sclerosis thology of sudden death in teenagers.report This de• of the left side of thecardiacskeleton, with involvement scribes three teenagers without clinically suspectedof heart theventricularseptum more on the rightventricular disease dying suddenly. Patient 1 (age 15, male)side was and involvement ofatrioventricular the bundle and known to have rightventricularprematureventricular trifascicularconduction system. beats.Postmortemexamination revealed marked pre• In conclusion, unexpected deaths in three teenagers matureaging, sclerosis of thecardiacskeleton extending occurred withdemonstrablepathologic findings in the to the right side of the summit with fibrosis of theheart. left Two of the three patients had mitral valve pro• and right bundlebranches.Patient 2 (age 17, male) waslapse, one of whom also had thrombosis or embolism of a trainedathlete who died during football scrimmage.thesinoatrialnodeartery.All three had sclerosis of not Autopsy revealed moderate mitral valve prolapseonly and the left side but alsothe right side ofthe ventricular markedprematureaging, sclerosis of the left side of theseptum with involvement of the conduction system. The cardiacskeleton, which extended to theventricular right anatomicsubstratedemonstratedin these three patients side, and secondary involvement oftrifascicular the con• could relate to lethalbradyarrhythmiaor tachyarrhyth• duction system with mononuclear cell infiltration.mia, Pa- or both.
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