Systemic lupus erythematosus, syncope, high degree atrio-ventricular block and Hisian pacemaker
Asensio-Lafuente, Enrique; Álvarez-de la Cadena, Jorge; Sánchez-Guevara, Emanuel
ABSTRACT
Introduction: Systemic Lupus Erythematosus (SLE) is frequently associated with ischemic heart disease, whereas other connective tissue diseases induce electrical conduction disturbances.
Presentation of case: a 54-year-old female had SLE diagnosed in 2008 and systemic arterial hypertension. The patient presented with syncope and dizziness. The electrocardiogram (ECG) showed bradycardia, Right Bundle Branch Block (RBBB), and 2° Mobitz II Atrio-Ventricular Block (AVB) while having hypokalemia. The electrolyte unbalance was corrected. A Holter and new ECG showed RBBB, anterior fascicle block, and 2° Mobitz II AVB again. A stress echocardiogram was negative for ischemia and showed an antegrade Wenckebach phenomenon at 110 beats per minute (545 ms). That sort of AVB suggested high requirements of ventricular stimulation. Thus, a double chamber pacemaker (DDD) with Hisian stimulation was implanted without acute complications. The patient has been followed up for four years and showed important shifts in stimulation thresholds, impedance, and in the selective (or not) His capture, sometimes determined by atrio-ventricular delay. This prompted recurrent programming changes.
Conclusion: His's stimulation in this subject has prevented new syncope episodes, but the behavior of stimulation thresholds and impedance in the presence of SLE seems unstable and requires frequent surveillance. Ventricular stimulation through the left bundle branch would now be preferred, but due to the scarcity of conduction disorders in SLE patients, more information is required.
