Guillain-Barré Syndrome with asystole requiring permanent pacemaker: a case report

Area of Science:

• Neurology
• Cardiology
• Immunology

Background:

• Guillain-Barré syndrome (GBS) is an autoimmune disorder targeting peripheral nerves.
• Autonomic dysfunction in GBS is typically temporary, but this case presents a persistent complication.
• We report a rare instance of GBS leading to permanent cardiac pacemaker dependency.

Purpose of the Study:

• To present a unique case of Guillain-Barré syndrome with persistent bradyarrhythmia.
• To highlight the potential for permanent cardiac conduction system damage in GBS.
• To emphasize the need for cardiac evaluation in GBS patients with severe autonomic dysfunction.

Main Methods:

• Case report of an 18-year-old female with GBS.
• Diagnosis confirmed by cerebrospinal fluid analysis (albuminocytologic dissociation).
• Treatment included intravenous immunoglobulin G and mechanical ventilation, followed by temporary and permanent pacemaker implantation due to persistent bradyarrhythmia and asystole.

Main Results:

• The patient developed severe quadriparesis and respiratory failure requiring mechanical ventilation.
• She experienced multiple episodes of bradycardia and asystole, necessitating pacemaker use.
• A permanent pacemaker was implanted due to persistent need, with ongoing requirement for ventricular pacing at follow-up.

Conclusions:

• Guillain-Barré syndrome can lead to irreversible damage to the cardiac conduction system.
• Patients with recurrent bradyarrhythmias and asystole in the context of GBS require thorough cardiac assessment.
• Consideration for permanent pacemaker implantation is crucial for managing persistent symptomatic bradyarrhythmia in GBS.