Atrioventricular block in childhood caused by mesothelioma

Our plain-English summary of Atrioventricular block in childhood caused by mesothelioma, by I.M. Hellemans, N.M. van Hemel, C.A. Kooyman (Pacing and Clinical Electrophysiology, 1981).

The study

• Authors: I.M. Hellemans, N.M. van Hemel, C.A. Kooyman
• Journal: Pacing and Clinical Electrophysiology
• Published: 1981;4(2):216-20
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The case of a girl who was first seen at 3.5 years of age with longstanding asymptomatic heart block is reported. Electrophysiological study disclosed a block proximal to the His bundle. She grew up normally until the age of 11.5 years, when a syncopal attack occurred. Before a pacemaker could be inserted, she suffered a second fatal attack. Necropsy revealed a tumor of the atrioventricular node diagnosed as mesothelioma. Our findings are compared to the 38 cases already described in the literature.

In plain English

This was a case report from the Netherlands of a girl with heart block caused by a tumor in the atrioventricular (AV) node of the heart, which the authors classified as mesothelioma. The article does not mention asbestos or any other exposure. The authors noted that the origin of this rare heart lesion is uncertain and has been suggested to be either endodermal or mesothelial. At 3.5 years her ECG showed second degree AV block. By 8.5 years she had third degree heart block, but because she had no symptoms a pacemaker was not recommended. At 11.5 years she collapsed while swimming and was resuscitated. She collapsed again and died while awaiting a pacemaker. Autopsy found a patch about 2.5 mm across in the AV junction, where abnormal tissue had almost completely replaced the normal structures. The authors compared her case with 38 published cases. They concluded that more postmortem examination of the conduction system was needed, because knowledge of the tumor's origin and natural history was extremely limited and no method was then available to diagnose it during life.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report of one patient, compared with cases described in the medical literature
• Who was studied: one girl, first seen at age 3.5 at St. Antonius Hospital, Utrecht, the Netherlands, followed until her death at age 11.5
• Exposure: No asbestos or other exposure is discussed. The tumor is a rare lesion of the heart's AV node whose origin the authors described as suggested to be either endodermal or mesothelial
• Main results:
  • At age 3.5 the girl's ECG showed sinus rhythm with second degree AV block
  • By age 8.5 she had developed third degree heart block with an escape rate of about 40 beats per minute
  • Because she had no symptoms, a pacemaker was not recommended at age 8.5
  • At 11.5 years, after a first collapse and resuscitation, she collapsed again and died while awaiting pacemaker implantation
  • At autopsy the heart weighed 275 g, against a normal weight of 140 g
  • Autopsy found a patch about 2.5 mm in diameter in the AV junction, where abnormal tissue had almost completely replaced the normal structures
  • In the authors' review of the literature, sudden death occurred in 20 of 38 previously described patients after a period without symptoms
• The authors' conclusion: The authors had expected a favorable outcome because the girl had no symptoms. They concluded that, because knowledge of the origin and natural history of mesothelioma of the AV junction was extremely limited and no methods were available to establish the diagnosis during life, more information from postmortem examination of the conduction system was needed.
• Limitations the authors state:
  • No ECG recordings of the fatal collapse were available, so other severe heart rhythm disturbances could not be excluded as the cause
  • At the time of the article, no methods were available to establish the diagnosis of this tumor during life

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Autopsy.

Related studies

• "Mesothelioma of the atrioventricular node" with long-standing complete heart block. Report of a case — I.R. Wanless, B.W. Mielke, et al. (1975)
• Fatal heart block due to mesothelioma of the atrioventricular node — D.W. Evans, P.G. Stovin (1986)
• Mesothelioma of the atrioventricular node and congenital complete heart block — R. Subramanian, B. Flygenring (1989)
• Mesothelioma of the atrioventricular node: first successful follow-up after excision — S. Balasundaram, S.A. Halees, et al. (1992)
• Mesothelioma of the atrioventricular node — K. Nishida, G. Kamijima, et al. (1985)
• Mesothelioma of the atrioventricular node — C. Ibarra-Perez, M.E. Korns, et al. (1973)

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