This case report demonstrates that total depletion and fatty replacement of the atrial muscle at the approaches to the AV node can cause progression from first-degree to third-degree AV block.
Supports fatty replacement at AV nodal approaches as rare mechanism in progressive AV block; leaves open generalizability beyond single case.
We report a case of a degenerative approach lesion in an 83-year-old male with diabetes mellitus, hypertension, and ischemic heart disease. His ECGs changed from first-degree atrioventricular (AV) block 14 years ago, to third-degree AV (A-H) block. A pacemaker was implanted for bradycardia. He died 4 years later from heart and renal failure. Serial sections through the conduction system revealed total depletion and fatty replacement of the atrial muscle at the approaches to the AV node.
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Kawai et al. (1992) studied this question.
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