Development of cardiac conduction disorders in a patient receiving basic therapy for systemic collagenoses: а case report

Abstract

Introduction. The problem of pacemaker implantation in atrioventricular (AV) block remains relevant, which creates conditions for a collegial approach taking into account personalized medicine in each specific case.

Brief description. A 70-year-old female patient was observed by an arrhythmologist for 9 months with second-degree type II AV block with transient third-degree AV block according to 24-hour electrocardiographic monitoring. A decision was made to implant a pacemaker, but the patient refrained from elective hospitalization. A detailed examination revealed that she was taking plaquenil and methylprednisolone as baseline therapy for collagenosis. Upon agreement with the rheumatologist, plaquenil was discontinued and the metypred dose was adjusted. Subsequently, the clinical condition remained without significant changes. However, according to the monitoring results, significant improvement was noted.

Discussion. This case demonstrates the need for a physician to take into account all patient data when prescribing treatment. Also, based on the considered case, the authors proposed a model for predicting fatal complications when detecting conduction disorders.