CARDIAC CONDUCTION SYSTEM INVOLVEMENT IN SUDDEN-DEATH OF OBESE YOUNG-PEOPLE
CARDIAC CONDUCTION SYSTEM INVOLVEMENT IN SUDDEN-DEATH OF OBESE YOUNG-PEOPLE
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DOI：
10.1016/0002-8703(95)90008-x
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发表时间：
1995-02-01
影响因子：
4.8
通讯作者：
LEV, M
中科院分区：
文献类型：
--
作者：
BHARATI, S;LEV, M
在肥胖年轻人的猝死中，传导系统的参与还没有文献记载。因此，我们通过连续切片检查对7名受试者的传导系统进行了研究，其中5名肥胖者和2名轻至中度肥胖者，他们分别在6岁、11岁、14岁、16岁、20岁、30岁和32岁突然死亡(5名男性，4名黑人和1名白人；2名女性，1名黑人和1名白人)。其中三人有睡眠呼吸暂停病史。6例心脏肥大，均有明显的室间隔膨出，心外膜冠状动脉正常。所有病例均在窦房结和/或其入路周围有局灶性单核细胞，3例有明显脂肪弥漫传导系统，5例房室束和/或左束支纤维化，5例分支束夹在球肌与室间隔顶端之间(左侧束2例，环状结构1例，束明显碎裂1例)。房室结部分位于中央纤维体和/或房间隔内6例，局灶性单个核细胞不同程度存在，室间隔局限性纤维化6例，动脉硬化4例，心肌紊乱3例。轻至中度肥胖者较重度肥胖者脂肪含量较少，纤维化较多。综上所述，在肥胖年轻人猝死的传导系统中有重要的病理发现。这一发现在长期肥胖和有阻塞性睡眠呼吸暂停病史的患者中更为明显。我们认为，这些发现可能确实会导致心律失常，这种心律失常在本质上可能是沉默的，但可能会形成一个心律失常事件的环境，在改变的生理状态下，心律失常事件可能会致命。
Involvement of the conduction system in the sudden death of obese young people has not been documented in the literature. We therefore studied the conduction system by serial section examination in 7 subjects, 5 obese and 2 mild to moderately obese, who died suddenly at ages 6, 11, 14, 16, 20, 30, and 32 years of age (5 males, 4 black and 1 white; two females, 1 black and 1 white). Three had a history of sleep apnea. The heart was hypertrophied and enlarged in 6; all 6 had a distinct ventricular septal bulge and epicardial coronary arteries were normal. All had focal mononuclear cells in and around the sinoatrial node and/or its approaches, with marked fat throughout the conduction system in 3, fibrosis of the atrioventricular (AV) bundle and/or the left bundle branch in 5, and the branching bundle sandwiched between the bulbar muscle and the summit of the ventricular septum in 5 (2 with left-sided bundle, 1 with loop formation, and 1 with a markedly fragmented bundle). The AV node was partly within the central fibrous body and/or the atrial septum in 6 patients; focal mononuclear cells were present to a varying degree, with focal fibrosis of the ventricular septum in 6 patients, arteriolosclerosis in 4, and myocardial disarray in 3. The mild to moderately obese patients demonstrated lesser amounts of fat with more fibrosis when compared with the markedly obese. In summary, there are significant pathologic findings in the conduction system in the sudden death of obese young people. The findings were more marked in patients with obesity of long-standing duration and a history of obstructive sleep apnea. We believe these findings may, indeed, produce arrhythmias that may be silent in nature but may form a milieu for an arrhythmic event that may end fatally during an altered physiologic state.