title: Sudden fetal death due to dualism of the sino-atrial node.
abstract: First, we report a sudden fetal death at 33(+3)weeks due to sino-atrial node dualism. The female stillborn was delivered by induced labor. The postmortem examination of the cardiac conduction system revealed a dualism of the sino-atrial node, associated with fragmentation of the atrio-ventricular node and His bundle. These abnormalities of the cardiac conduction system represent the morphological substrate for the development of malignant arrhythmias. In particular, the dualism of the sino-atrial node can cause the dissociation of the longitudinal nodal impulse into two distinct ways of different pulse generation, resulting in supraventricular tachyarrhythmias. This observation suggests new avenues of research on the pathogenesis of the sudden unexpected fetal death. Moreover, our findings confirm the need for an accurate postmortem examination, including serial sectioning of the cardiac conduction system, in every case of unexplained fetal death, following standardized autoptic protocols.
authors.affiliation: Provincial Health Care Services, Institute of Pathology, Santa Maria del Carmine Hospital, Rovereto, TN, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Pusiol
authors.affiliation: Provincial Health Care Services, Institute of Pathology, Santa Maria del Carmine Hospital, Rovereto, TN, Italy; Department of Diagnostic and Clinical Medicine and of Public Health, University of Modena and Reggio Emilia, Modena, MO, Italy. Electronic address: emailmedical@gmail.com.
authors.forename: Luca
authors.initials: L
authors.lastname: Roncati
authors.affiliation: Department of Biomedical, Surgical and Dental Sciences, Lino Rossi Research Center, University of Milan, Milan, MI, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Lavezzi
authors.affiliation: Provincial Health Care Services, Unit of Obstetrics and Gynecology, Santa Maria del Carmine Hospital, Rovereto, TN, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Taddei
authors.affiliation: Provincial Health Care Services, Institute of Pathology, Santa Maria del Carmine Hospital, Rovereto, TN, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Piscioli
authors.affiliation: Department of Biomedical, Surgical and Dental Sciences, Lino Rossi Research Center, University of Milan, Milan, MI, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Ottaviani
mesh_terms: D001344:Autopsy; D005260:Female; D005333:Fetus; D006801:Humans; D066087:Perinatal Death / Q000209:etiology*; D011247:Pregnancy; D012849:Sinoatrial Node / Q000002:abnormalities*; D050497:Stillbirth
keywords: Autopsy; Cardiac conduction system; Dualism; Fetal dispersion; Fetus; Sino-atrial node; Sudden intrauterine unexplained death syndrome (SIUDS)