scholarly journals Complete heart block in a 40-year-old man with anti-SSA/Ro autoantibodies

2020 ◽  
pp. 201010582097866
Author(s):  
Raja Ezman Raja Shariff ◽  
Chiao Wen Lim ◽  
Sazzli Kasim
Keyword(s):  
Lupus Erythematosus ◽  
Heart Block ◽  
Antinuclear Antibodies ◽  
Complete Heart Block ◽  
Pacemaker Implantation ◽  
The Elderly ◽  
Permanent Pacemaker ◽  
Delayed Presentation ◽  
High Degree ◽  
Lupus Syndrome

Atrio-ventricular dissociation (AVD), including complete heart block (CHB), are far more common in the elderly. We report a rare case of CHB in a 40-year-old man, who tested positive for anti-Ro autoantibodies without systemic features. He had been suffering for giddiness over the previous two months. On arrival, his electrocardiogram revealed high-degree AVD. Upon further history, he mentioned that his 68-year-old mother with systemic lupus erythematosus (SLE) had suffered from similar episodes, requiring a permanent pacemaker implantation. On further investigation, he tested positive for antinuclear antibodies (ANA), anti-SSA/Ro and anti-RNP antibodies. However, from history and clinical examination, he had not manifested any articular, extra-articular or extra-glandular features suspicious of rheumatological conditions. Following a failed trial of intravenous hydrocortisone, he subsequently had a permanent pacemaker implanted himself. Although difficult to ascertain whether our patient suffered from a congenital form of anti-SSA/Ro-related CHB, there is evidence to suggest delayed presentation of CHB in those with anti-SSA/Ro and neonatal lupus syndrome. Anti-SSA/Ro antibodies without systemic features can be present in 3% of the population, although this occurs more commonly in the presence of a confirm diagnosis of SLE, Sjögren’s syndrome or poly- and dermatomyositis. Despite the scarcity of evidence, a trial of steroid-based treatment was attempted prior to subjecting the young patient to a permanent pacemaker and its associated complications. To our knowledge, this is only the second case of isolated anti-SSA/Ro syndrome presenting with CHB reported in the literature.

Rates of permanent pacemaker implantation for complete heart block complicating pregnancy: a nationwide analysis of 20,451,108 pregnant patients in the USA

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Gonuguntla ◽  
S.P Patil ◽  
C Rojulpote ◽  
Z.E Borja ◽  
P.E Bravo ◽  
...  
Keyword(s):  
Lupus Erythematosus ◽  
Heart Block ◽  
Complete Heart Block ◽  
Average Length ◽  
Case Reports ◽  
Pacemaker Implantation ◽  
International Classification Of Diseases ◽  
Permanent Pacemaker ◽  
Permanent Pacemaker Implantation ◽  
The Usa

Abstract Introduction Complete heart block (CHB), also known as third-degree heart block, occurs when there is complete dissociation of the atria and ventricles. CHB during pregnancy is extremely rare and one possible mechanism may be related to the stretching of the atria during pregnancy causing conduction defects Purpose There is limited data on the rates of CHB and pacemaker (PPM) use in pregnant patients, with only a few case reports published. In this study we sought to define the rates of permanent pacemaker implantation for CHB complicating pregnancy. Methods The Nationwide Inpatient Sample was queried from 2010 to 2014 using the International Classification of Diseases, 9th revision diagnosis codes for pregnancy and CHB and procedure codes for PPM in any procedure field for patients 18 years or older. Results From 2010 to 2014, we identified 20,451,108 pregnancies in patients above the age of 18 years. The overall rates of CHB were 643 (0.0031%). The sample consisted of 643 patients (Mage= 29.28±6.42 years) with CHB, the majority of whom were Caucasians 328 (51%). Average length of stay (LOS) (M ± SD) was 4.94±7.859 and total hospitalization charges were 51,715.04±112,345.98 ($). Moreover, the occurrence of other conditions which could lead to the development of CHB was: sarcoidosis 0 (0%), systemic lupus erythematosus 5 (0.8%), prior myocardial infarction 25 (3.8%), Lyme disease 0 (0%). Among patients with CHB, PPM implantation was done in 60 (9.3%), and TVP were 5 (0.8%). The overall composite mortality rates were 21 (3.2%). On comparing the non-PPM group to the PPM group, rates of in-hospital mortality were 3.6% vs 0%; p=0.059, LOS were 4.49±5.01 vs 12.50±15.35; p<0.001, complications such as congestive heart failure 0% vs 8.4%; p<0.001, cardiogenic shock 1% vs 8.4%; p<0.001, respiratory failure needing mechanical ventilation 1.7% vs 0; p<0.04, sudden cardiac death 3.4% vs 0; p<0.05. Conclusions The overall rates of CHB were 3.1 in 100,000 pregnancies. There were no reported in-hospital deaths among pregnant patients with CHB who received PPM and TVP. Relatively lower rates of PPM implantation in these patients might indicate that CHB during pregnancy is less severe and patients may have a stable narrow complex junctional escape rhythm. PPM implantation is recommended for those who are symptomatic or have a slow wide QRS complex rhythm indicating a block below the bundle of His.With this study we attempt to better define the occurrence of CHB during pregnancy, which could lead to better understanding and management of this condition. Funding Acknowledgement Type of funding source: None

scholarly journals Mucormycosis: An Uncommon Cutaneous Infection at Permanent Pacemaker-Implanted Site in a Very Low-Birthweight Baby

2022 ◽  
Author(s):  
Minati Choudhury ◽  
Jitin Narula ◽  
Milind P. Hote ◽  
Sarita Mohapatra
Keyword(s):  
Heart Block ◽  
Low Birthweight ◽  
Pulse Generator ◽  
Complete Heart Block ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Cutaneous Infection ◽  
Very Low Birthweight ◽  
Congenital Complete Heart Block ◽  
Life Threatening

AbstractPermanent pacemaker implantation in low birthweight (LBW) babies with congenital complete heart block is extremely challenging due to a paucity of appropriate pulse generator placement pocket sites. The development of infection following an implantation procedure can pose a life-threatening risk to the patients. With more patients in the younger group receiving these devices than ever before and the rate of infection increasing rapidly, a closer look at the burden of infection and its impact on outcome of these patients is warranted. We report mucormycosis infection at the abdominal pacemaker pocket site of an infant requiring pacemaker explantation and re-insertion into the intrapleural space.

scholarly journals Case Report: Complete heart block as a manifestation of cardiac metastasis of oral cancer

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 1243
Author(s):  
Andrianto Andrianto ◽  
Eka Prasetya Budi Mulia ◽  
Denny Suwanto ◽  
Dita Aulia Rachmi ◽  
Mohammad Yogiarto
Keyword(s):  
Pericardial Effusion ◽  
Heart Block ◽  
Complete Heart Block ◽  
Tongue Cancer ◽  
Pacemaker Implantation ◽  
Metastatic Tumor ◽  
Variable Number ◽  
Permanent Pacemaker ◽  
Cardiac Metastasis ◽  
Temporary Pacemaker

Metastatic tumors of the heart presenting with complete heart block (CHB) is an extremely uncommon case. There are no available guidelines in managing CHB in terminal cancer. Permanent pacemaker implantation in such cases is a challenge in terms of clinical utility and palliative care. We report a case of a 24-year-old man suffering from tongue cancer presenting with CHB. An intracardiac mass and moderate pericardial effusion were present, presumed as the metastatic tumor of tongue cancer. We implanted a temporary pacemaker for his symptomatic heart block and cardiogenic shock, and pericardiocentesis for his massive pericardial effusion. We decided that a permanent pacemaker would not be implanted based on the low survival rate and significant comorbidities. Multiple studies report a variable number of cardiac metastasis incidence ranging from 2.3% to 18.3%. It is rare for such malignancies to present with CHB. The decision to implant a permanent pacemaker is highly specific based on the risks and benefits of each patient. It needs to be tailored to the patient’s functional status, comorbid diseases, prognosis, and response to conservative management.

Complete heart block in lupus

Lupus ◽  
2019 ◽  
Vol 28 (13) ◽  
pp. 1589-1593
Author(s):  
A Natsheh ◽  
D Shimony ◽  
N Bogot ◽  
G Nesher ◽  
G S Breuer
Keyword(s):  
Lupus Erythematosus ◽  
Heart Block ◽  
Complete Heart Block ◽  
Permanent Pacemaker ◽  
Initial Manifestation ◽  
Intraventricular Conduction ◽  
Dna Antibodies ◽  
Electrocardiographic Findings ◽  
Antibody Tests

Conduction abnormalities are uncommon in adult patients with lupus. We present a young woman with recurrent syncope caused by third-degree atrio-ventricular block as the initial manifestation of lupus and review 31 additional cases of systemic lupus erythematosus patients that have been described previously with complete heart block. Heart blocks occurred almost exclusively in females. The median age was 37 years. In 24 cases heart blocks were diagnosed in patients with established lupus. In only five patients, including the patient presented here, heart blocks were diagnosed before the lupus diagnosis. Syncope was the most common presenting symptom of heart block. Electrocardiographic findings prior to heart block episodes were reported in 17 cases: eight had normal findings, but nine had already variant forms of atrioventricular or intraventricular conduction defects. Anti-nuclear antibody tests were reported in 25 cases and were all positive. Anti-DNA antibodies were also common and were positive in 16 of 19 cases (84%). Anti-La and anti-Ro antibodies were less common (13% and 35%, respectively). Three patients died, all prior to 1975. Heart block resolved in 10 cases. Follow-up was reported in four of these cases and heart block recurred in three of them. A permanent pacemaker was the eventual treatment in 22 cases. The etiology of lupus-associated complete heart block is not clear. It is probably variable, possibly related to effects of autoantibodies reacting with the conduction system, myocardial disease and adverse effects of antimalarials. Insertion of a permanent pacemaker seems to be the preferable method of treatment.

scholarly journals Case Report: Complete heart block as a manifestation of cardiac metastasis of oral cancer

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 1243
Author(s):  
Andrianto Andrianto ◽  
Eka Prasetya Budi Mulia ◽  
Denny Suwanto ◽  
Dita Aulia Rachmi ◽  
Mohammad Yogiarto
Keyword(s):  
Pericardial Effusion ◽  
Heart Block ◽  
Complete Heart Block ◽  
Tongue Cancer ◽  
Pacemaker Implantation ◽  
Metastatic Tumor ◽  
Variable Number ◽  
Permanent Pacemaker ◽  
Cardiac Metastasis ◽  
Temporary Pacemaker

Metastatic tumors of the heart presenting with complete heart block (CHB) is an extremely uncommon case. There are no available guidelines in managing CHB in terminal cancer. Permanent pacemaker implantation in such cases is a challenge in terms of clinical utility and palliative care. We report a case of a 24-year-old man suffering from tongue cancer presenting with CHB. A intracardiac mass and moderate pericardial effusion were present, presumed as the metastatic tumor of tongue cancer. We implanted a temporary pacemaker for his symptomatic heart block and cardiogenic shock, and pericardiocentesis for his massive pericardial effusion. We decided that a permanent pacemaker would not be implanted based on the low survival rate and significant comorbidities. Multiple studies report a variable number of cardiac metastasis incidence ranging from 2.3% to 18.3%. It is rare for such malignancies to present with CHB. The decision to implant a permanent pacemaker is highly specific based on the risks and benefits of each patient. It needs to be tailored to the patient’s functional status, comorbid diseases, prognosis, and response to conservative management.

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