Lo C H, Wei J C C, Tsai C F, Li L C, Huang S W, Su C H
1 Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung City, Taiwan.
2 Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital; Institute of Medicine, Chung Shan Medical University; Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.
Lupus. 2018 Sep;27(10):1729-1731. doi: 10.1177/0961203318782425. Epub 2018 Jun 28.
Systemic lupus erythematosus (SLE) can affect all heart structures including the conduction system, with either reversible or permanent derangement. However, only a few cases of adult SLE and complete atrioventricular (AV) block have been reported. We describe a young pregnant woman who initially presented with complete AV block on electrocardiography before the diagnosis of SLE. Syncope subsequently developed during the postpartum period due to frequent nonsustained polymorphic ventricular tachycardia, suggesting lupus myocarditis. The ventricular arrhythmia was successfully treated by intravenous corticosteroids, lidocaine and implantation of a permanent pacemaker. This may represent the first report of complete AV block with polymorphic ventricular tachycardia, which was identified before the other clinical features of SLE fully manifested. SLE should be considered if a patient presents with complete AV block without other clinical features. It may warn for early diagnosis and appropriate treatment of SLE including lupus-related heart disease.
系统性红斑狼疮（SLE）可累及包括传导系统在内的所有心脏结构，导致可逆或永久性紊乱。然而，仅有少数成人SLE合并完全性房室（AV）传导阻滞的病例报道。我们描述了一名年轻孕妇，在诊断SLE之前，心电图最初表现为完全性AV传导阻滞。产后因频繁发作的非持续性多形性室性心动过速出现晕厥，提示狼疮性心肌炎。静脉注射皮质类固醇、利多卡因及植入永久性起搏器成功治疗了室性心律失常。这可能是完全性AV传导阻滞合并多形性室性心动过速的首例报道，且该病例在SLE的其他临床特征充分显现之前就已确诊。如果患者出现无其他临床特征的完全性AV传导阻滞，应考虑SLE。这可能为SLE包括狼疮相关心脏病的早期诊断和恰当治疗提供警示。
