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Case report: acute myocarditis complicated with persistent complete heart block: a clinical dilemma when myocardial

Maria Rita Lima1, Pedro Custódio2, António Tralhão1,3

  • 1Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Universitário de Lisboa Ocidental, EPE, Avenida Prof. Dr. Reinaldo dos Santos 2790-134, Lisbon, Portugal.

European Heart Journal. Case Reports
|April 5, 2024
PubMed

Insights

Acute myocarditis can cause persistent complete heart block (CHB), requiring pacemaker implantation. This case highlights rare instances where myocardial inflammation leads to irreversible conduction system damage, necessitating advanced pacing strategies.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Infectious Diseases

Background:

  • Acute myocarditis typically causes transient atrioventricular conduction abnormalities.
  • Persistent complete heart block (CHB) after acute myocarditis is uncommon but can necessitate permanent pacing.
  • Selective injury to the heart's conduction system may result from myocardial inflammation.

Observation:

  • A 23-year-old man presented with acute lymphocytic myocarditis, cardiogenic shock, ventricular fibrillation, and persistent CHB.
  • Endomyocardial biopsy revealed subacute myocarditis with Epstein-Barr virus (EBV) DNA detected via RT-PCR.
  • Despite favorable cardiac function recovery, CHB persisted for over three weeks.

Findings:

  • The patient underwent successful left bundle branch pacing for definitive CHB management.
  • EBV infection was identified as the likely etiology, though viral RNA was not detected in situ.
  • This case underscores the potential for irreversible conduction system damage in acute myocarditis.

Implications:

  • Rare cases of myocarditis can lead to irreversible conduction abnormalities requiring permanent device implantation.
  • Further research is needed to elucidate mechanisms of conduction system predilection in myocarditis.
  • Management of persistent CHB in young patients may involve advanced pacing techniques like LBB pacing.
Abstract

Keywords:
Cardiogenic shockCase reportComplete heart blockEndomyocardial biopsyMyocardial inflammationMyocarditis

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