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題名 | Reversible Infra-Hisian Atrioventricular Block in Acute Myocarditis=急性心肌炎造成之可自然恢復的希氏束下房室傳導阻斷 |
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作者 | 尤登弘; 郭必芳; 陳勉成; 楊正旭; | 書刊名 | 長庚醫學 |
卷期 | 24:10 2001.10[民90.10] |
頁次 | 頁651-656 |
分類號 | 415.3165 |
關鍵詞 | 心傳導阻斷; 心肌炎; 希氏束下房室傳導阻斷; Heart block; Myocarditis; Infra-hisian atrioventricular block; |
語文 | 英文(English) |
英文摘要 | Symptomatic second- or third-degree atrioventricular (AV) block at any anatomical level is a class I indication for permanent pacemaker implantation. We describe a 44-year-old male with acute viral myocarditis who suffered from syncope followed by a seizure attack associated with AV conduction disturbance. His initial electrocardiogram in our emergency room revealed sinus tachycardia with 2:1 AV conduction and a right bundle branch block QRS morphology with a ventricular rate of 60 beats/min. Because of episodic slowing of the heart rate below 40 beats/min, he received 1 mg atropine intravenously which increased the atrial rate but further worsened the AV conduction, resulting in ventricular asystole for more than 30 seconds associated with loss of consciousness and seizure-like activity. He was immediately paced transcutaneously and transferred to the catheterization laboratory to receive temporary transvenous cardiac pacing. The cardiac catheterization study showed a normal coronary angiogram and very mild diffuse hypokinesis. Electrophysiological studies revealed advanced infra-Hisian AV block. The infra-Hisian AV block, however, resolved rapidly in 2 days. The patient did not receive a permanent pacemaker and remained asymptomatic with normal electrocardiogram over 1 year of follow-up. We suggest that symptomatic infra-Hisian AV block due to viral myocarditis can be reversible, and implantation of a permanent pacemaker may not be necessary. |
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