Ventricular fibrillation without apparent heart disease: Description of six cases

Martini, Bortolo; Nava, Andrea; Thiene, Gaetano; Buja, Gian Franco; Canciani, B; Scognamiglio, R; Daliento, Luciano; Volta, Sergio Dalla

doi:10.1016/0002-8703(89)90011-2

Cited by 314 publications

(157 citation statements)

References 22 publications

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“…Approximately 50% of all medico -legal deaths are due to natural causes and 1-5% of all those cases remain as negative autopsies against to all odds (1)(2)(3)(4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Evaluation Of Cardiac Conduction System In Sudden Deaths

Zhao

Zhang²,

Li³

2013

Adli Tip Derg

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Objective:In this study, revealing the regional characteristics of the cardiac conduction system pathologies in sudden death cases is aimed. Besides, this is the first study of Adana region forensic cases related to the cardiac conduction system pathologies. Methods:Twenty seven cases of sudden unexpected death and 4 cases with known causes of death as a control group have been included in the study. Samples from sinoatrial node and atrioventicular node were taken in total 31 cases. Samples were evaluated with light microscope after staining through histochemical staining methods. Results:There were significant pathological changes of the sinoatrial node and atrioventricular node in 10 of the cases. And in 3 of all cases (11.1%), the abnormalities of the conduction system were considered to have the possibility for causing death. Conclusion:We have concluded that it is of importance to evaluate the cardiac conduction system in sudden unexpected death cases and this topic should be kept in sight in forensic pathology.Key words: forensic pathology, cardiac conduction system, sudden death, autopsy ÖZET Amaç:Bu çalışmada, ani kardiyak ölüm vakalarında kardiyak ileti sistemi patolojilerinin bölgesel özelliklerinin ortaya konması amaçlandı. Ayrıca bu çalışma, kardiyak ileti sistemi patolojileri konusunda Adana bölgesindeki adli olgularda yapılan ilk çalış-madır. Yöntemler:Yirmi yedi ani-beklenmedik ölüm olgusu ile ölüm nedeni bilinen 4 olgu kontrol grubu olarak çalışmaya alındı. Toplam 31 olguda, sinoatrial nod ve atrioventriküler nod bölgelerinden örnekler alındı. Örnekler histokimyasal boyama yöntemleri ile boyanarak ışık mikroskobunda incelendi. Bulgular:Ani-beklenmedik ölüm olgularının 10'unda sinoatrial nod ve atrioventriküler nodda belirgin patolojik bulgular saptandı. Tüm olguların 3'ünde (%11,1), ileti sistemi anomalilerinin ölüme neden olabileceği düşünüldü. Sonuç:Ani beklenmedik ölüm olgularında kardiyak ileti sistemi değerlendirmesinin önemli olduğu ve adli patolojide bu konunun göz önünde bulundurulması gerektiği sonucuna vardık. (2,13,14,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) Grade I (+): Irregular widening of the myofibrils or small amounts of fibrosis, adipose tissue infiltration less than 25%, random mono nuclear cellular accumulation.Grade II (++): Small amounts of irregular fibrous tissues and irregular myofibrils, 25-50% of adipose tissue infiltration, 25-50% luminal obliteration of the arteries, accumulations of mono nuclear cellular infiltration. 2,13,28). We think that it may be a result of the differences between the regional dietary habits as well as the higher average age in our study (2,(12)(13)(14)28 (12,13,18,29 (4,13,(30)(31)(32)(33)(34) (14,21,(42)(43)(44) (2,13,16,26,27,46 271. Gordon I, Shapiro HA. Forensic Medicine, 2nd Ed., Edinburg, London, Melbourne, New York: Longman Group Limited, 1982. 2. Cohle SD, Saurez-Mier MP, Aguilera B. Sudden death resulting from lesions of the cardiac conduction system. Am J Foren Med Path 2002;23:83-9. 3. Denfield SW...

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“…Approximately 50% of all medico -legal deaths are due to natural causes and 1-5% of all those cases remain as negative autopsies against to all odds (1)(2)(3)(4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Evaluation Of Cardiac Conduction System In Sudden Deaths

Zhao

Zhang²,

Li³

2013

Adli Tip Derg

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“…9 Interestingly, an ECG pattern similar to coved-type ST-segment elevation was previously reported as a normal variant in the healthy population or related to VF in patients with structural cardiac abnormality. 10,11 Subsequently, a group of Italian researchers considered it as a form of arrhythmogenic right ventricular cardiomyopathy. 12 The identification of the first putative casual gene mutation in 1998 clarified the controversy confirming the genetic nature of the disease.…”

Section: Brugada Syndrome and Early Repolarisationmentioning

confidence: 99%

Brugada Syndrome and Early Repolarisation: Distinct Clinical Entities or Different Phenotypes of the Same Genetic Disease?

Conte

Caputo

Regoli

et al. 2016

Arrhythmia &Amp; Electrophysiology Review

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General understanding of early repolarisation (ER) has dramatically changed in the last decade. For several years, ER has been considered a benign electrocardiographic (ECG) finding with high prevalence in the general population. Recently different studies have challenged this view and showed a significant association with life-threatening arrhythmias. [1][2][3][4][5] In 2008 Haïssaguerre et al. first reported an increased prevalence of a particular pattern of ER on the resting 12-lead ECG of patients with history of idiopathic ventricular fibrillation (VF) (see Figure 1). 2 In these patients, ER was characterised by elevation of the QRS-ST segment junction of at least 0.1 mV above the baseline level, manifesting as QRS slurring (a smooth transition from the QRS complex to the ST segment) or notching (a positive J deflection of at least 1 mm inscribed on the S wave) in two adjacent inferior (II, III and aVF), lateral (I, aVL, and V4-V6), or infero-lateral leads. The ER pattern was observed in 31 % of patients with idiopathic VF and in 5 % of healthy control subjects.Moreover, patients with idiopathic VF and ER pattern presented a higher risk of experiencing an arrhythmic recurrence during a 5-year follow-up.2 This observation was confirmed by a case-control study showing that J-point elevation in the inferior and lateral leads is more frequent in patients with idiopathic VF than in matched control subjects (27 % versus 8 % in inferior leads; 13 % versus 1 % in lateral leads).3 Conversely, ER localised exclusively in V4 to V6 occurs with similar frequency among patients and healthy subjects.

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“…15,16 In 1989, Martini et al 15 described 6 patients with apparently idiopathic ventricular fibrillation, 3 of whom had the ECG pattern of early repolarization in right precordial leads. In these patients, underlying structural abnormalities of the right ventricle were clinically documented.…”

Section: Is the Brugada Syndrome A Cardiomyopathy? (D Corrado)mentioning

confidence: 99%

Diagnostic and genetic aspects of the Brugada and other inherited arrhythmias syndromes

Antzelevitch

Wilde

Eckardt

et al. 2007

Journal of Electrocardiology

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Doctor Wilde, presenting on behalf of himself and Dr Eckardt, discussed the role of invasive and noninvasive tests for risk stratification of Brugada syndrome. Doctor Hiraoka, presenting on behalf of Y. Yokoyama, M. Takagi, N. Aihara, K. Aonuma, and the Japan Idiopathic Ventricular Fibrillation Study Investigators, further discussed the diagnostic criteria for the Brugada syndrome. Doctor Antzelevitch examined the hypothesis that amplification of spatial dispersion of repolarization in the form of transmural dispersion of repolarization underlies the development of life-threatening ventricular arrhythmias associated with inherited ion channelopathies including the long QT, short QT, and Brugada syndromes. Doctor Corrado discussed the relationship between channelopathies and heart muscle diseases. KeywordsArrhythmia; Sudden cardiac death; Ventricular tachycardia; Fibrillation; Electrophysiology; Channelopathies Role of invasive and noninvasive tests for stratification (A. Wilde and L. Eckardt)Brugada syndrome is increasingly recognized as a disease entity associated with sudden cardiac death (SCD), most often, in relatively young individuals without structural heart disease. The typical ECG is characterized by right precordial ST-segment elevation and discrete prolongation of diverse conduction parameters. Three types of ST-segment elevation are recognized, but only one, type 1 (ie, the 'coved-type' ST segment), is considered to be diagnostic of Brugada syndrome. When a type 1 ECG is associated with documented (or inducible) ventricular arrhythmias, premature SCD or similar ECGs in family members, or nocturnal agonal respiration, Brugada syndrome is diagnosed. 1,2 When the ECG is absent at baseline, drug challenge (iv flecainide, ajmaline procainamide, pilsicainide, or other sodium channel blockers) can unmask the ECG features. A genetic diagnosis can identify 18% to 30% of patients with SCN5A mutations. It is not essential for definitive diagnosis of the syndrome.

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Ventricular fibrillation without apparent heart disease: Description of six cases

Cited by 314 publications

References 22 publications

Evaluation Of Cardiac Conduction System In Sudden Deaths

Evaluation Of Cardiac Conduction System In Sudden Deaths

Brugada Syndrome and Early Repolarisation: Distinct Clinical Entities or Different Phenotypes of the Same Genetic Disease?

Diagnostic and genetic aspects of the Brugada and other inherited arrhythmias syndromes

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