Crib death: further support for the concept of fatal cardiac electrical instability as the final common pathway

Abstract

This work intends to be a review of the current status of knowledge on the cardiac conduction system in the crib death as well as remaining challenges, including reflections upon authors' personal works as well as many studies by others. The cardiac conduction system findings of resorptive degeneration, His bundle dispersion, Mahaim fibers, cartilaginous meta-hyperplasia, persistent fetal dispersion, left sided His bundle, hemorrhage of the atrio-ventricular junction, septation of the bifurcation, atrio-ventricular node dispersion, sinus node hypoplasia, Zahn node, His bundle hypoplasia, atrio-ventricular node and His bundle dualism are hereby discussed by the authors. The cardiac hypotheses postulating that crib death could be due to lethal cardiac arrhythmias or heart block were considered of great interest in the 1970s. After a general abandon of the conduction studies in crib death, the cardiac concept of crib death is gathering a renewed interest, as well as the occurrence of infantile junctional tachycardia. Both the morphological and functional derangement underlying crib death remain poorly understood, assuring that it remains to be a major medical and social problem. Despite the non-specificity of most of the cardiac conduction findings in crib death, we believe that they, in association with altered neurovegetative stimuli, could underlie potentially malignant arrhythmias, providing a morphologic support for the cardiac concept of crib death. D

Study of the Brainstem, Particularly the Arcuate Nucleus, in Sudden Infant Death Syndrome (SIDS) and Sudden Intrauterine Unexplained Death (SIUD)

“…15 Recent studies have stressed the frequent alterations, mainly congenital in nature, of both the autonomic nervous system, central and peripheral, and the cardiac conduction system. 11,12,16,17 Limiting the study of the autonomic nervous system to the brainstem, the congenital anomalies represented by dendritic spines, markers of neuronal immaturity, and most of all by hypoplasia of ARCn are of particular interest and frequency. 8 -12 Recent observations point out that such developmental alterations appear with a similar incidence in SIDS and SIUD victims.…”

Early atherosclerotic lesions of the cardiac conduction system arteries in infants

“…All intervening sections were kept and stained as deemed necessary. For each heart, the average number of histologic sections stained and examined is about 200, as described [12].…”

Maternal smoking and sudden infant death syndrome: epidemiological study related to pathology

“…The cardiac conduction system was removed in two blocks: the first included the sinoatrial node and the crista terminalis, the second contained the atrioventricular node, His bundle down to the bifurcation, and bundle branches. These two blocks were serially cut at intervals of 40-μm (levels) and stained alternately with hematoxylin-eosin and Azan [35,36,42].…”