The histopathology of the cardiac conduction system was studied in 75 coroners' autopsies. Existing methods have been simplified and are described in detail. A minimum of three ***5 u sections need to be cut from each vena cavo atrial strip and each atrio ventricular block, for a successful result. Reasons for failure, difficulties in interpretation, and age-related changes in histopathological features are discussed. Fatty infilteration commences at 33 years old and fibrosis at 43 years old. Conduction system studies do not seem to increase the accuracy of routine autopsy diagnosis in deaths due to coronary artery disease. However, its study in unexpected sudden death in the young should be made compulsory. The difficulties in performing choline esterase tests on conduction systems are also highlighted.
Get full access to this article
View all access options for this article.
References
1.
BancroftJohn D. (1966) Observations on effect of histochemical reactions on different processing methods. J. Med. Lab. Techn.23, 105–8.
2.
CarbonellLuis M. (1956) Esterases of the conductive system of heart. J. Histochem. Cytochem.4, 87–95.
3.
DaviesM. J. (1971) Pathology of conducting tissues of heart. Butterworths. p7.
4.
DaviesM. J.PomeranceA. (1972) A quantitative study of ageing changes in the human SA node and internodal tracts. Brit. Heart J.34, 150.
5.
DaviesM. J.PomeranceA. (1975) The pathology of heart. Blackwell scientific publications. p. 368.
6.
DaviesM. J.PoppleA. (1979) Sudden unexpected cardiac death—a practical approach to the forensic problem. Histopathology.3, 255–77.
7.
FerrisJamesA. J. (1974) Conducting tissue changes in sudden death. Med. Sci. Law.14, 36–9
8.
GeeD. J. (1969) A glycoprotein in cardiac conducting tissue. Brit. Heart J.31, 588–90.
9.
GomoriG. (1948) Histochemical demonstration of sites of choline esterase activity. Soc. Exp. Biol. Med.68, 354–8.
10.
HudsonR. E. B. (1967) Surgical pathology of the conducting system of the heart. Brit. Heart J.29, 646.
11.
JamesT. N.FranceB.SchatzI. J. (1964) Pathology of cardiac conduction system in Marians Syndrome. Arch. Intern. Med.114, 339.
12.
JamesT. N.FroggatMarshallT. K. (1967) Sudden death in young athletes. Ann. Intern. Med.67, 1013.
13.
LevM. (1964) The pathology of complete atrio ventricular block. Progr. Cardiovascular Dis.6, 317.
14.
LevM.AlvinL.WatneL. (1954) Method for routine histopathological study of human sino atrial node. A.M.A. Arch. Path.57, 168–76.
15.
LevM.WidranJ.EricksonE. E. (1951) Method for histological study of atrioventricular node bundle and branches. A.M.A. Arch. Path.52, 73–83.
16.
LevM.UngerP. M. (1955) The pathology of the conduction system in acquired heart disease. Arch. Path.60, 502.
17.
LieJ. T. (1975) Histopathology of the conduction system in sudden death from coronary heart diseasesCirculation.51, 446–52.
18.
LieJ. T.TitusJ. L. (1975) Pathology of the myocardium and the conduction system in sudden coronary deathCirculation (Supplement III) 51, 41–52.
19.
LumbG. (1960) The relationship of sudden death to lesions of cardiac conduction tissue. Second international meeting on forensic pathology and medicine. New York City.
20.
LumbG. D.ShacklettR. S. (1960) Human cardiac conduction tissue lesions. Am. J. Path.36, 411–27.
21.
MeredithJ.TitusJ. L. (1968) The anatomical atrial connections between sinus and A-V node. Circulation.37, 566.
22.
OlsenE. G. J. (1980) Pathology of heart.Macmillan Press Ltd, London. pp 17–18.
23.
PearseA. G. E. (1972) Histochemistry: theoretical and applied J. and A. Churchill, London. p. 1312.
24.
PedersenKvist P. (1980) For. Sci. Int.16, 281–2.
25.
RossiL. (1978) ‘Ageing changes in the atrio ventricular node and nervous system’. In: Histopathology of Cardiac arrthmias (2nd edn).
26.
TitusJ. L.DaughertyG. W.EdwardsJ. E. (1963) Anatomy of normal human atrio ventricular conduction system. Amer. J. Anal.113, 407.
27.
TruexR. C.SmytheM. Q. (1966) ‘Recent observations on human conduction system with special considerations of the atrio ventricular node and bundle. In: Electrophysiology of heart.Pergamon Press, Oxford.
28.
VoigtJorgen (1976) Reflections of the value of histological examination of the cardiac conduction system in cases of natural unexpected death. Med. Sci. Law.8, 29–31.
