SUMMARY A patient with Mobitz type 2 heart block caused by a mesothelioma of the atrioventricular node died of a subarachnoid haemorrhage at the age of 33 two years after implantation of a permanent pacemaker. Mesothelioma of the atrioventricular node is rare, and reported cases have all been diagnosed post mortem. Mesothelioma of the atrioventricular node should be considered in the differential diagnosis of heart block in children or young adults. This is the first case to be reported in Japan.Case report A 31 year old man was admitted to hospital because of poor appetite. On routine physical examination, a grade 2/6 systolic murmur was heard at the left sternal border. No cyanosis was noted. The liver was not palpable. Serum aspartate aminotransferase and alanine aminotransferase activities were 58 U/l and 29 U/I respectively. A liver biopsy showed a cirrhotic pattern, and he was diagnosed as having alcoholic cirrhosis.At night his heart rate fell to 30 beats/min, and an electrocardiogram showed 2:1 atrioventricular block with a narrow QRS complex (Fig. 1). His bundle electrograms were recorded using standard catheter techniques. The HV interval was normal (30 ms) and the AH interval prolonged (150 ms).
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