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Advanced atrioventricular conduction block in acute rheumatic fever

Published online by Cambridge University Press:  24 May 2005

Eli Zalzstein ,
Rachel Maor ,
Nili Zucker  and
Amos Katz
Eli Zalzstein
Affiliation:
Pediatric Cardiology Unit, Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Rachel Maor
Affiliation:
Pediatric Cardiology Unit, Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Nili Zucker
Affiliation:
Pediatric Cardiology Unit, Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Amos Katz
Affiliation:
Pediatric Cardiology Unit, Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Abstract

We carried out a retrospective case control analysis to evaluate the outcome, and the need for treatment, of problems with atrioventricular conduction occurring during an acute attack of rheumatic fever, assessing the occurrence of second and third atrioventricular block versus first degree block.

We reviewed and analysed the clinical, electrocardiographic and echocardiographic records of all children diagnosed in a single institute as having acute rheumatic fever during a period of seven consecutive years.

During the period from October, 1994, through October, 2001, 65 children meeting the modified Jones criterions for acute rheumatic fever were hospitalized in the Soroka University Medical Center, Israel. First-degree atrioventricular block was identified in 72.3% of the children, and resolved with no specific treatment other than non-steroidal anti-inflammatory medications. Second-degree atrioventricular block of Mobitz type I, was observed in one child (1.5%), which progressed from first-degree block, and subsequently resolved. Complete atrioventricuar block was found in 3 children (4.6%), one progressing from Mobitz type I second-degree block, and two being seen as the first presentation. Of the three children with complete atrioventricular block, one patient was not treated, the second was treated with aspirin, and the final one with combined aspirin and steroids. The disturbances of conduction resolved in all three.

We conclude that advanced atrioventricular block is rare during acute rheumatic fever. If occurring, block appears to be temporary, and resolves with conventional anti-inflammatory treatment. Specific treatment, such as insertion of a temporary pacemaker, should be considered only when syncope or clinical symptoms persist.

Keywords

Rheumatic fevercarditisatrioventricular dissociation
Type
Original Article
Information
Cardiology in the Young , Volume 13 , Issue 6 , December 2003 , pp. 506 - 508
Copyright
© 2003 Cambridge University Press

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References

Land MA, Bisno AL. Acute rheumatic fever: a vanishing disease in suburbia. JAMA 1983; 249: 895–898.Google Scholar
Markowitiz M. The decline in rheumatic fever: Role of medical intervention. J Pediatr 1985; 106: 545–550.Google Scholar
Gordis L. The virtual disappearance of rheumatic fever in the United States: lessons the rise and fall of disease. Circulation 1985; 72: 1155–1162.Google Scholar
Ferrieri P. Acute rheumatic fever, the come back of disappearing disease. Am J Dis Child 1987; 141: 725–727.Google Scholar
Hosier DM, Craenen JM, Teske DW, Wheller JJ. Resurgence of acute rheumatic fever. Am J Dis Child 1987; 141: 730–733.Google Scholar
Guidelines for the diagnosis of rheumatic fever. Jones Criteria. 1992 update. Special Writing Group of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young of the American Heart Association. JAMA 1992; 268: 2069–2074.
Clark M, Keith JD. Atrio ventricular conduction in acute rheumatic fever. Br Heart J 1972; 34: 472–479.Google Scholar
Phornphutkul C, Damrongsak D, Silpisornkosol S. Steroid therapy in cardiac conduction disturbances in children with diphtheria. Mod Med Asia 1978; 38: 43–44.Google Scholar
Uemura A, Morimoto S, Hiramitsu S, Hishida H. Endomyocardial biopsy finding in 50 patients with idiopathic atrioventricular block: presence of myocarditis. Jpn Heart J 2001; 42: 691–700.Google Scholar
Malik JA, Hassan C, Khan GO. Transient complete heart block complicating acute rheumatic fever. Indian Heart J 2002; 54: 91–92.Google Scholar
Thakur AK. Complete heart block as a first manifestation of acute rheumatic fever. Indian Heart J 1996; 48: 428–429.Google Scholar
Shah CK, Gupta R. Persistent complete heart block following acute rheumatic fever in a 12 year old girl. Jassoc Physician India 1993; 41: 389–390.Google Scholar
Lenox CC, Zuberbuhler JR, Park SC, Neches WH, Mathews RA, Zoltun R. Arrhythmias and Stoke-Adams attack in acute rheumatic fever. Pediatrics 1978; 61: 599–603.Google Scholar
Freed MS, Sacks P, Ellman MH. Ventricular tachycardia in acute rheumatic fever. Arch Intrn Med 1985; 145: 1904–1905.Google Scholar
Liberman L, Hordof AJ, Alfayyadh M, Salafia CM, Pass RH. Torsade de pointes in a child with acute rheumatic fever. J Pediatr 2001; 138: 280–282.Google Scholar
Singhi S, Shrivastava S. Sinus node dysfunction in acute rheumatic carditis: a case report. Indian Heart J 1979; 31: 305–308.Google Scholar
Goldstein I, Halpern B, Robert L. Immunological relationship between streptococcus A polysaccharide and the structural glycoproteins of heart valve. Nature 1967; 213: 44–49.Google Scholar
Gee DJ. A glycoprotein in cardiac conducting tissue. Br Heart J 1969; 31: 588–590.Google Scholar
Cristal N, Stern J, Gueron M. Atrioventricular dissociation in acute rheumatic fever. Br Heart J 1971; 33: 12–15.Google Scholar