Author + information
- Received June 18, 1990
- Revision received October 15, 1990
- Accepted November 2, 1990
- Published online July 1, 1991.
- Saroja Bharati, MD, FACC1,*,
- William B. Moskowitz, MD, FACC†,
- Melvin Scheinman, MD, FACC‡,
- N.A. Mark Estes III, MD, FACC§ and
- Maurice Lev, MD, FACC*
- ↵1Address for reprints: Saroja Bharati, MD, Congenital Heart and Conduction System Center, 11745 Southwest Highway, Palos Heights, Illinois 60463.
The conduction system was studied by serial section in three patients with intractable supraventricular tachycardias originating from the atrioventricular (AV) junction who died suddenly. The three patients were a 6 month old girl (Case 1), a 5 month old boy (Case 2) and a 22 year old woman (Case 3). The latter had a pacemaker inserted after surgical ablation of the AV node. The heart was hypertrophied and enlarged in all.
In Case 1, the AV node was partly within the central fibrous body and there was a left-sided AV bundle with acute necrosis in the summit of the ventricular septum, adjacent to the AV node and bundle. In Case 2, the coronary sinus was displaced cranially close to the central fibrous body, resulting in abnormality of the latter, with entrapment, distortion and division of the AV node and bundle into two distinct components within the central fibrous body. In Case 3, a left-sided AV node was connected to the atrial septum. The right AV node was completely interrupted by sutures and the penetrating and branching bundle and bundle branches were markedly fibrosed. In addition, the atrial septum and summit of the ventricular septum showed marked inflammatory reaction with fibrosis, which was more marked on the right ventricular side.
Histologic examination of the conduction system in all three cases demonstrated congenital abnormalities of the AV junction that may be related to the tachycardia. These findings emphasize the need to carefully evaluate the atrial septum and AV junctional area, including the coronary sinus, before ablative procedures are undertaken. Finally, these anomalies at the AV junctional area may be elusive on clinical evaluation, but have important implications for ablative procedures performed from the right-sided approach.
- Received June 18, 1990.
- Revision received October 15, 1990.
- Accepted November 2, 1990.
- American College of Cardiology Foundation