Advanced heart block and atrial flutter in a patient with HLA B27 spondyloarthropathy.

An athletic 43-year-old man presented with symptomatic bradycardia and atrial flutter after being diagnosed with HLA B27 associated spondyloarthropathy several months earlier. The patient was admitted and underwent electrophysiology evaluation with ablation of his atrial flutter and eventually underwent pacemaker implantation. His cardiac workup showed a structurally normal heart and strongly suggested that his HLA B27 associated spondyloarthropathy was responsible for his presentation. A review of the literature suggests that HLA B27 spondyloarthropathy related heart block may be an often overlooked cause of heart block in otherwise healthy patients.