The Myocardial Conduction System in Sudden Death in Infancy

Abstract

THE ultimate mechanism responsible for sudden unexpected death in infancy remains unknown. Current hypotheses tend toward the concept of an instantaneous interruption in some basic physiologic function such as the control of respiration or cardiac action.¹ In 1968 James² proposed the hypothesis that these deaths are due to lethal disturbances in the conduction system triggered by focal "histopathologic changes" in the atrioventricular bundle and the atrioventricular node. The histologic features that he described are focal resorptive degeneration of conduction tissue cells, cell death, removal of dead cells by macrophages and replacement with collagen produced by young fibroblasts. These abnormalities were . . .