Complete atrioventricular block in a patient with rheumatoid arthritis

Atrioventricular (AV) block is rare in patients with rheumatoid arthritis (RA), but it is usually of complete type. A 55-year-old woman had complaints of fatigue, dizziness, and light-headedness, all of a week history. She had been receiving treatment for RA for about six years, and had been on methylprednisolone 5 mg/day for a year. On physical examination, her heart rate was 32 bpm, blood pressure was 160/80 mmHg. She had a grade 1-2/6 apical systolic ejection murmur. The electrocardiogram showed complete AV block. Transthoracic echocardiography showed grade I mitral regurgitation. No rheumatoid nodule was noted on transesophageal echocardiography. Coronary arteries appeared normal on coronary angiography. A temporary pacemaker was implanted in the coronary care unit, after which complete AV block improved to a second-degree Mobitz type II block. Her heart rate was 45 bpm. As no further improvement was observed in the AV block during a 10-day monitoring, she underwent DDD-R permanent pacemaker implantation.