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Atropine/prednisolone Lack of efficacy in complete atrioventricular block: case report

A 59-year-old woman exhibited lack of efficacy while receiving atropine and prednisolone for complete atrioventricular (AV) block. The woman, who had a long-term history of dilated cardiomyopathy (DCM) and clinical manifestations of congestive heart failure (CHF), was hospitalised due to recurrent paroxysmal supraventricular tachycardias (SVT). She had been receiving enalapril 5 mg/day, bisoprolol 5 mg/day, eplerenone 25 mg/day and torasemide 5 mg/day. On admission, an electrocardiogram (EKG) showed a sinus rhythm with a HR of 60 beats/minute, AV conduction time at the upper limit of normal, and a complete left bundle branch block (LBBB). Transthoracic echocardiography showed a decrease in the ejection fraction (EF) of the left ventricle (LV), and an expansion of all cardiac cavities, an increase in the end-diastolic volume (EDV) of the LV and the end-systolic volume (ESV) of the LV, and zones of violation of the local contractility of the myocardium of the LV were absent. Subsequently, a complete AV block without a replacement ventricular rhythm was noted. During the observation period for one hour, the complete AV block persisted. Hence, she was treated with atropine and prednisolone [dosages and routes not stated]; however, the treatment was ineffective. Thereafter, she required a transvenous temporary pacemaker (PM) system. Haemostasis was performed, and she was shifted to the ICU. Three hours following the intervention, her AV conduction restored. The attempts to remove temporary PM electrode led to the development of a complete AV block and ventricular asystole. Considering DCM with a decreased LVEF, presence of CHF symptoms, a concomitant complete LBBB and the expected high percentage of right ventricular pacing, a device for cardiac resynchronising therapy was implanted without complications. Subsequently, her condition improved. Utsumueva MD, et al. Paroxysmal supraventricular tachycardia in patient with dilated cardiomyopathy and concomitant cardiac conduction defects: A case report and discussion. [Russian]. Cardiovascular Therapy and Prevention (Russian Federation) 19: 78-85, No. 3, 2020. Available from: URL: http:// doi.org/10.15829/1728-8800-2020-2368 [Russian; summarised from a translation]

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Reactions 10 Oct 2020 No. 1825