Transient Atrioventricular Conduction Disturbances in a Case of Severe Fever with Thrombocytopenia Syndrome.

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Severe fever with thrombocytopenia syndrome (SFTS) complicated by progressive atrioventricular conduction disturbances (n=1). Intervention: Temporary transvenous pacemaker insertion (with supportive favipiravir, filgrastim, recombinant thrombomodulin, and meropenem). Primary outcome: Spontaneous recovery of atrioventricular conduction without permanent pacemaker implantation.

Q: What does this research mean for the field?

Severe fever with thrombocytopenia syndrome can cause reversible high-degree atrioventricular block even in the absence of clinically overt myocarditis. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Masahiro Yamamoto; Ken‐ei Sada; Satoshi Kawada; 降幡 多栄子; Sachiko Muramatsu; Daichi Miyamoto; Akihiko Yano; Kohei Miyashita; Yuichi Saisaka; Takayuki Ishii

doi:10.18926/amo/71343

October 1, 2026Open Access

Transient Atrioventricular Conduction Disturbances in a Case of Severe Fever with Thrombocytopenia Syndrome.

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Key result

Temporary transvenous pacing safely manages transient complete AV block and severe asystole in SFTS.

n=1

Key Points

To describe a case of progressive and transient atrioventricular conduction disturbances culminating in complete heart block in a patient with severe fever with thrombocytopenia syndrome (SFTS).
Clinical, laboratory, and electrophysiological evaluation of a 79-year-old woman hospitalized with RT-PCR-confirmed SFTS.
Diagnostic workup included continuous electrocardiography, transthoracic echocardiography, cardiac magnetic resonance imaging, coronary computed tomography, and serial cardiac biomarker measurements.
On hospital day 6, first-degree atrioventricular block progressed to transient complete atrioventricular block, resulting in syncope and a 15-second asystolic pause at 12:53.
Echocardiography showed preserved ventricular function, cardiac magnetic resonance imaging did not support clinically overt myocarditis, and troponin I rose from 15.7 pg/ml on day 1 to 50.6 pg/ml on day 6 and 389.4 pg/ml on day 10.
Following temporary transvenous pacemaker insertion, atrioventricular conduction recovered spontaneously, allowing pacing discontinuation on day 9 without permanent pacemaker implantation.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 female patient (age 79) in Japan with severe fever with thrombocytopenia syndrome (SFTS) and no prior conduction disease, followed for 23 days during hospitalization.

I

Intervention

Temporary transvenous pacemaker inserted via the right internal jugular vein set to ventricular demand pacing at 50 beats/min from hospital day 6 to day 9, alongside supportive medical therapy (favipiravir, filgrastim, recombinant thrombomodulin, and meropenem).

O

Outcome

Recovery of atrioventricular conduction and clinical stabilization

Severe fever with thrombocytopenia syndrome (SFTS) can cause reversible complete atrioventricular block even without clinically overt myocarditis, highlighting the need for continuous ECG monitoring and timely temporary pacing rather than immediate permanent pacemaker implantation.

Limitations

Single patient case report
Endomyocardial biopsy was not performed, so focal or subclinical myocardial involvement could not be fully excluded
Cardiac magnetic resonance imaging was obtained 16 days after the onset of conduction disturbance
Precise mechanism of atrioventricular block could not be definitively established
Endomyocardial biopsy was not performed
Cardiac magnetic resonance imaging was obtained 16 days after the onset of conduction disturbance, so focal or subclinical myocardial involvement cannot be fully excluded
The precise mechanism of AV block could not be definitively established

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Implication

May favor temporary pacing over permanent implantation in SFTS-related transient AV block; leaves open prevalence and mechanisms.

Abstract

A 79-year-old woman with severe fever with thrombocytopenia syndrome (SFTS) developed progressive atrioventricular (AV) conduction disturbances during hospitalization. On hospital day 6, first-degree AV block progressed to transient complete AV block, causing syncope and a 15-sec asystolic pause. Echocardiography showed preserved ventricular function, and cardiac magnetic resonance imaging did not support clinically overt myocarditis. A temporary transvenous pacemaker was inserted, and AV conduction recovered spontaneously; pacing was discontinued by day 9 without permanent pacemaker implantation. This case suggests that SFTS can cause reversible high-degree AV block and may warrant continuous twelve-lead electrocardiography (ECG) monitoring and timely temporary pacing.

Discussion

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Cite This Study

Yamamoto et al. (2026) conducted a case report in Severe fever with thrombocytopenia syndrome (SFTS) complicated by progressive atrioventricular conduction disturbances (n=1). Temporary transvenous pacemaker insertion (with supportive favipiravir, filgrastim, recombinant thrombomodulin, and meropenem) was evaluated on Spontaneous recovery of atrioventricular conduction without permanent pacemaker implantation. Temporary transvenous pacing successfully managed a 15-second asystolic pause from transient complete AV block in a 79-year-old woman with SFTS, with spontaneous recovery by hospital day 9.

synapsesocial.com/papers/6ae5317cf47c78c6bae4b9b1 https://doi.org/10.18926/amo/71343

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Transient Atrioventricular Conduction Disturbances in a Case of Severe Fever with Thrombocytopenia Syndrome.

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Transient Atrioventricular Conduction Disturbances in a Case of Severe Fever with Thrombocytopenia Syndrome.

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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