Histopathology of the Conduction System in Long QT Syndrome

Rogers, Alexandra; Taylor, Rachel A.; Poulik, Janet; Shehata, Bahig M.

doi:10.1080/15513815.2021.2002988

Cited by 2 publications

(1 citation statement)

References 10 publications

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“…In our case, it is possible that eosinophilic infiltration could have triggered a malignant arrhythmia in a genetically predisposed heart. LQTS can correlate with heart structural anomalies (e.g., enlargement of the left atrium) [ 76 , 77 ], and has been rarely associated with microscopic features such as focal fibrosis and lipomatosis of the cardiac conduction system (CCS) and focal round cell ganglionitis of sympathetic trunks described in the scientific literature [ 78 , 79 ]. However, as mentioned, this is the first case in which an eosinophilic infiltrate of the SAN was found in a case of SD, and the potential correlation between this feature and LQTS is still to be explained.…”

Section: Discussionmentioning

confidence: 99%

Eosinophilic Infiltration of the Sino-Atrial Node in Sudden Cardiac Death Caused by Long QT Syndrome

Grassi

Campuzano

Coll

et al. 2022

IJMS

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Sudden death is defined as the unexpected death of a healthy person that occurs within the first hour of the onset of symptoms or within 24 h of the victim being last seen alive. In some of these cases, rare deleterious variants of genes associated with inherited cardiac disorders can provide a highly probable explanation for the fatal event. We report the case of a 21-year-old obese woman who lost consciousness suddenly in a public place and was pronounced dead after hospital admission. Clinical autopsy showed an inconclusive gross examination, while in the histopathological analysis an eosinophilic inflammatory focus and interstitial fibrosis in the sino-atrial node were found. Molecular autopsy revealed an intronic variant in the KCNQ1 gene (c.683 + 5G > A), classified as likely pathogenic for long QT syndrome according to the guidelines provided by the American College of Medical Genetics and Genomics. Therefore, there were many anomalies that could have played a role in the causation of the sudden death, such as the extreme obesity, the cardiac anomalies and the KNCQ1 variant. This case depicts the difficult interpretation of rare cardiac structural abnormalities in subjects carrying rare variants responsible for inherited arrhythmic disorders and the challenge for the forensic pathologist to make causal inferences in the determinism of the unexpected decease.

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