Introduction: A variety of diseases, besides the common Lev-Lenegre’s disease, can cause heart conduction system abnormalities. These include: Acute rheumatic fever, sarcoidosis, connective tissue disorders, neoplasm and bacterial endocarditis.
Objectives:The purpose of the study is to raise awareness of these rare conditions.
Patients and Methods: We present nine adult patients with various rare causes of heart block, who needed pacemaker therapy (temporary or permanent): I. A 33-year-old female who suffered acute rheumatic fever and transient complete atrio-ventricular block (CAVB). II. A 19-year-old soldier with a history of acute rheumatic carditis, who presented with recurrent syncope. Serial ECG recordings demonstrated inappropriate sinus bradycardia and AV dissociation. III. A 43-year-old female suffering from Wegener granulomatosis, proven by nasal mucosa biopsy and intermittent CAVB. IV. A 68-year-old female, with known metastatic breast cancer with pericardial involvement, presented with syncope and CAVB. V. A 69-year-old female presented with CAVB was diagnosed as having bacterial endocarditis, with abcess formation along the conduction system . VI. A 43-year-old male, presented with Stokes-Adams syndrome. On chest X-ray, CT and Gallium-scan, there was evidence of hilar lymphadenopathy, he was diagnosed with Sarcoidosis. VII. A 42-year-old man presented with intermittent 2:1 AV Block. The patient had been treated with Radiotherapy to the Mediasinum for Lymphoma 25 years previously, and on a CT scan of his chest, there is evidence of heavy calcificactions of the 3 coronary arteries, the root of the Aorta, Aortic valve and Mitral Annulus. VIII. A 49-year-old male, presented with CAVB. This young patient has quadriplegia and syringomyelia, following a road accident, 11 years ago. IX. A 43-year-old female presented with symptomatic congenital CAVB, and was treated with pacemaker therapy .
Conclusions: We suggest that patients with these disorders should be followed at regular intervals, thus allowing early detection and treatment of heart conduction disturbances.