Complete Atrioventricular Block Following Myocarditis in Children

Abstract

Complete atrioventricular block (CAVB) can be either congenital or acquired in children. Acquired CAVB is occasionally seen in myocarditis patients. To determine the etiology, natural history, and outcome of children with acquired nonsurgical CAVB, we retrospectively reviewed nine children who had suffered CAVB caused by suspected infectious myocarditis. All of them had CAVB with a wide QRS escape ventricular rhythm on admission. Three of them had ventricular tachycardia in addition to CAVB. Seven of them had a preceding upper respiratory tract infection. All of them had congestive heart failure. Five of them had Stokes-Adams seizures. Three etiologies were identified in four of the children. All patients received inotropic agents and emergency temporary pacing. In all except one case, the cardiac rhythm returned to sinus rhythm within 10 days. During a follow-up period of 9 to 96 months, all were asymptomatic and drug-free. Electrocardiograms showed that four patients were completely normal, there was complete RBBB in four and left anterior fascicular block in one patient. We conclude that although CAVB associated with myocarditis can be life-threatening, the long-term prognosis is good if patients are diagnosed early and proper management is employed.

Heart block in infant with atypical myocarditis: a case report and review of literature

“…First-or seconddegree AV-block has been found in 12.6% of children with proven or suspected myocarditis, whereas persistent advanced heart block is very rare [2]. The data is limited for infants with only a few reported cases of myocarditis associated with heart block [3,4]. The characteristics of these cases including that of our patient are summarized in Table 1.…”

“…The degree of cardiomegaly is usually related to the extent of myocardial inflammation and therefore is considered as one of the poor prognostic factors [7]. Wang et al [3] reported an incidence of 22% of cardiomegaly in children with myocarditis with complete heart block. The low incidence of cardiomegaly in such cases is probably due to suboptimal heart rate secondary to advanced heart block.…”

The Specifics and Way of Atrioventricular Block Course in Infants Myocarditis

“…Wang J, et al сообщили о развитии кардиомегалии у детей с миокардитом и полной АВБ в 22% случаев [10]. В обследуемой нами группе кардиомегалия была выявлена у всех детей и ассоциировалась не с тяже-стью течения миокардита, а с наличием выраженной для данного возраста брадикардии, что подтверждено фактом нормализации размеров камер сердца после имплантации ЭКС.…”

“…Патогенез нарушений АВ-проведения на фоне вирусного процесса обусловлен отеком и поврежде-нием клеток проводящей системы сердца, что приво-дит к нарушению проведения от блокады ножек пучка Гиса до полной АВБ [6,10].…”

Seizures and Syncope Due to Complete Atrioventricular Block in a Patient with Acute Myocarditis with a Normal Left Ventricular Systolic Function

“…Previous reports have shown that AdamsStokes attacks or syncope can occur due to the sudden onset of complete AV block in patients with acute nonspecific myocarditis, especially children and young adults (1-16). There are eight previous reports of seizures occurring due to complete AV block with acute myocarditis in children and adolescents (1,(7)(8)(9)(10)(14)(15)(16) and only one precise case in adults (13). This indicates that children and young adults are particularly vulnerable to these complications.…”