Dissecting the Cardiac Conduction System: Is It Worthwhile?

Serena Y. Tan, Michael K. Fritsch, Steven White, Nicoleta C. Arva*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Pathologic examination of conduction system (CS) is not routinely performed, and histologic changes are mostly reported in forensic practice. Methods: We studied the value of dissecting the CS in a cohort of pediatric patients with unexplained sudden death or severe, inexplicable arrhythmias. Histopathologic changes present in CS components were recorded and correlated with findings noted in other cardiac structures. Results: Twenty-one subjects (11 unexplained sudden deaths and 10 life-threatening arrhythmias) were identified; 18 (86%) had CS pathologic abnormalities. In 13 patients (62%), the CS findings mirrored those found in other cardiac sections (inflammation, allograft vasculopathy, vascular fibromuscular dysplasia, cardiomyopathy-related changes, and tumor/tumor-like conditions). Five cases (24%) had abnormalities restricted to CS (bundle of His [BH] with fibrotic scar and patch material following ventricular septal defect repair, inflammation, BH with fibrosis and calcifications, and intimal fibroplasia of sinoatrial node artery). Conclusions: Pathologic changes within the CS are present in a high number of pediatric patients presenting with unexplained sudden death or life-threatening arrhythmias. Frequently, the findings mirror those observed in other cardiac structures. However, in a significant number of cases (24%), the changes are restricted to CS and likely explain the patients’ symptoms or cause of death, suggesting that systematic dissection of CS unveils valuable information.

Original languageEnglish (US)
Pages (from-to)413-423
Number of pages11
JournalPediatric and Developmental Pathology
Issue number6
StatePublished - Dec 2020
Externally publishedYes


  • arrhythmia
  • atrioventricular node
  • bundle of His
  • channelopathy
  • conduction system
  • sinoatrial node
  • sudden death

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pathology and Forensic Medicine


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