Highlights a rare case of irreversible complete A-V block requiring permanent pacing due to regional myocardial scarring from Coxsackie B2 myocarditis.
May prompt consideration of septal aneurysm in post-myocarditis AV block; single case leaves causal role and prevalence open.
Transient atrioventricular (A-V) conduction abnormalities are often experienced in patients with evolving acute viral myocarditis, but persistent complete A-V block requiring permanent cardiac pacing is rare. We describe a case who developed irreversible complete A-V block during the long-term course of Coxsackie B2 myocarditis. The endomyocardial biopsy revealed inflammatory cellular infiltrates and myocyte necrosis. A left ventriculogram and echocardiogram consistently demonstrated an aneurysm in the basal portion of the interventricular septum. It was speculated that the extensive myocardial scar caused by acute myocarditis resulted in the ventricular aneurysm of this particular myocardial region involving the A-V conduction system.
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Sato et al. (1989) studied this question.
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