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Sudden cardiac deaths have higher proportion of left stellate ganglionitis

Abstract

One of the hypothesized mechanisms of sudden cardiac death in humans is an arrhythmia precipitated by increased sympathetic outflow to a compromised heart. The stellate ganglia provide the main sympathetic innervation to the heart, where the left stellate ganglion appears to play a role in arrhythmogenesis. Case reports of sudden cardiac death have described left stellate ganglion inflammation but no larger studies have been performed. Thus, we have specifically assessed whether the left stellate ganglion was inflamed in those dying from sudden cardiac death versus other causes of death. Thirty-one left stellate ganglia were resected from cadavers diagnosed with sudden cardiac deaths and compared with 18 ganglia from cadavers diagnosed with non-sudden cardiac deaths. Ganglia were stained with hematoxylin and eosin and lymphocytic aggregates compared. The proportion of left stellate ganglion inflammation (77%) was significantly higher in deaths from sudden cardiac deaths than non-sudden cardiac deaths (33%). This study provides information on a previously recognized, but understudied, structure that may help understand sudden cardiac death. We found high prevalence of stellate ganglion inflammation and propose that this may trigger sympathetic storms.

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Acknowledgements

The authors would like to thank the forensic technicians for their dissection expertise, and doctors Kilak Kesha, Charley Glenn, and Paul Morrow in assisting in the preparation of the manuscript.

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Correspondence to Rexson Tse.

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Tse, R., Garland, J., McCarthy, S. et al. Sudden cardiac deaths have higher proportion of left stellate ganglionitis. Forensic Sci Med Pathol 18, 156–164 (2022). https://doi.org/10.1007/s12024-022-00466-5

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  • DOI: https://doi.org/10.1007/s12024-022-00466-5

Keywords

  • Sudden cardiac death
  • Sympathetic nervous system
  • Stellate ganglion
  • Inflammation
  • Cardiac arrhythmia
  • Cardiovascular disease