Complete heart block in lupus

Abstract

Conduction abnormalities are uncommon in adult patients with lupus. We present a young woman with recurrent syncope caused by third-degree atrio-ventricular block as the initial manifestation of lupus and review 31 additional cases of systemic lupus erythematosus patients that have been described previously with complete heart block. Heart blocks occurred almost exclusively in females. The median age was 37 years. In 24 cases heart blocks were diagnosed in patients with established lupus. In only five patients, including the patient presented here, heart blocks were diagnosed before the lupus diagnosis. Syncope was the most common presenting symptom of heart block. Electrocardiographic findings prior to heart block episodes were reported in 17 cases: eight had normal findings, but nine had already variant forms of atrioventricular or intraventricular conduction defects. Anti-nuclear antibody tests were reported in 25 cases and were all positive. Anti-DNA antibodies were also common and were positive in 16 of 19 cases (84%). Anti-La and anti-Ro antibodies were less common (13% and 35%, respectively). Three patients died, all prior to 1975. Heart block resolved in 10 cases. Follow-up was reported in four of these cases and heart block recurred in three of them. A permanent pacemaker was the eventual treatment in 22 cases. The etiology of lupus-associated complete heart block is not clear. It is probably variable, possibly related to effects of autoantibodies reacting with the conduction system, myocardial disease and adverse effects of antimalarials. Insertion of a permanent pacemaker seems to be the preferable method of treatment.

Comorbidity of Dermal and Cardiovascular Disorders with Lichen Sclerosus: A Case-control Study

“…We did not find any publications about conduction defects related to LS. In lupus erythematosus, conduction defects have been reported, but are uncommon ( 13 ). The aetiology is unclear, but the effects of autoantibodies reacting with the conduction system, myocardial disease, and adverse effects of antimalarials have all been suggested as a cause ( 13 ).…”

“…In lupus erythematosus, conduction defects have been reported, but are uncommon ( 13 ). The aetiology is unclear, but the effects of autoantibodies reacting with the conduction system, myocardial disease, and adverse effects of antimalarials have all been suggested as a cause ( 13 ). Autoantibodies might also be related to conduction defects in LS.…”

First-in-human wireless left ventricular endocardial pacing in a patient with obliterated venous system and complete heart block

“…In this case, we present a new and innovative use of the WiSE-CRT system in a patient with unfortunate complete heart block, likely a rare finding in systemic lupus erythematosus with positive anti-ribonucleoprotein antibodies. 5 The patient had multiple complex comorbidities, including end-stage renal disease necessitating hemodialysis. The patient had multiple transvenous ports over the years in the common iliac and subclavian veins bilaterally.…”

Management of Complete Heart Block in a Pregnant Woman with Systemic Lupus Erythematosus-Associated Complications: Treatment Considerations and Pitfalls

“…A study by Natsheh et al researched case reports of CHB in lupus and found only four anti-Ro/SSA and two anti-La/SSB positive cases out of 32, therefore suggesting other possible pathophysiological mechanisms involved in SLE-induced conduction defects. Additionally, Natsheh et al discovered that 84% of CHB cases were anti-DNA positive and 100% were ANA positive [ 16 ]. Our patient’s anti-Ro/SSA and/or anti-La/SSB antibodies during the pregnancy period were also not elevated but both anti-DNA and ANA were positive.…”

“…Our patient’s anti-Ro/SSA and/or anti-La/SSB antibodies during the pregnancy period were also not elevated but both anti-DNA and ANA were positive. Furthermore, a literature review of CHB cases with lupus erythematosus revealed that CHB almost exclusively involves women (30/32, 94%) and more importantly, the most common CHB manifestation in these women is syncope [ 16 ]. Since the probability of preexisting heart disease (such as ischemic heart disease, etc.)…”