Cohen S I, Bharati S, Glass J, Lev M
Arch Intern Med. 1981 Apr;141(5):676-9.
A 20-year-old man contracted Hodgkin's disease and was treated with mantle radiotherapy. Heart block developed 11 years later. Electrocardiograms revealed predominant atrioventricular (AV) block and occasional AV conduction. Intracardiac electrograms demonstrated that the site of AV block was above the level of the His bundle. A permanent transvenous pacemaker was implanted. Seven months later the patient died of complications from cryptococcal meningitis. Pathological study of the heart revealed marked arteriosclerosis with fibrosis of the epicardium, myocardium, and endocardium. Examination of the conduction system revealed extensive arteriolosclerosis of the sinoatrial node and its approaches. In addition, there was marked fibrosis of the approaches to the AV node, the AV bundle, and both bundle branches. There was no evidence of Hodgkin's disease. This case documents the rare occurrence of AV block due to tissue destruction by radiotherapy. There was a good correlation between block proximal to the His bundle recording site and fibrosis of the approaches to the AV node.
一名20岁男性患霍奇金病，接受了斗篷野放射治疗。11年后出现心脏传导阻滞。心电图显示主要为房室（AV）阻滞，偶尔有AV传导。心内心电图显示AV阻滞部位在希氏束水平之上。植入了永久性经静脉起搏器。7个月后，患者死于隐球菌性脑膜炎并发症。心脏病理研究显示有明显的动脉硬化，伴有心外膜、心肌和心内膜纤维化。传导系统检查显示窦房结及其周围有广泛的小动脉硬化。此外，房室结、房室束及其两个束支周围有明显纤维化。没有霍奇金病的证据。该病例记录了放疗导致组织破坏引起AV阻滞的罕见情况。希氏束记录部位近端的阻滞与房室结周围纤维化之间有良好的相关性。
