Acute rheumatic fever is a disease that is very common in developing countries. Heart involvement is responsible for morbidity and mortality. Mitral and aortic valve insufficiency and stenosis, congestive heart failure, myocarditis and pericarditis can be seen. Even if carditis does not develop during the course of the disease, many rhythm and conduction defects may occur. These include all degrees of atrioventricular block, sinus tachycardia and bradycardia, atrial and ventricular premature beats, accelerated junctional rhythm, supraventricular tachycardia, junctional and ventricular tachycardia. In this review, rhythm and conduction defects that may occur in acute rheumatic fever disease, which continues to be an important public health problem, were discussed in the light of the literature.