Lino Rossi, Andrea Finzi*, Marco Borgioli, Luigi Matturri.
Institute of Pathology, University of Milan, *Institute of Cardiology, Ospedale Maggiore IRCCS, Milan, Italy
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A pathological approach, with a clinical-instrumental
support, to 14 cases with hypertrophic and/or hypertensive heart disease leading to failure of
the contractile efficiency in patients suffering from different (cardiomyopathies from hypertrophic
to atherosclerotic coronary and Chagas disease).
Besides the increased heart weight all specimens, examined on serial sections of the conduction
system, exhibited fine fibrotic replacement of its terminal arborizations, often extended to a
similar change of the so-called Purkinje myocardial subendocardial junctions.
These fine conduction-impairing abnormalities [all cases have showed a wide QRS complex, up to
overt-left bundle branch (LBB) block in two] once were labelled as “arborization block”.
The constant more or less severe atherosclerotic narrowing of the septal arteries suggested a
chronic ischemic damage to the conduction system terminal spreading. Consistent with this concept
was the clinical-instrumental evidence of the case with hypertensive cardiac hypertrophy in whom
while performing heart - nuclear imaging of stress-test, complete AV block supervened due to
posteroinferior ischemia.
This, in the authors’ opinion, upholds the concept that chronic heart failure to be significantly
ascribed to ventricular contractile impairment from desynchronised intraventricular conduction
which, in turn, bespeaks for the rationale of inherent correction by adapt pacemaker treatment.
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