Conduction Disturbances and
Inflammatory Heart Disease
C. Piper, D. Horstkotte
Conduction disturbances can be caused by a large
variiety of inflammatory processes involving the heart. The
predominant histomorphologic findings are focal or diffuse
inflammatory cell infiltration, edema, myocytolysis, and/or fibrosis.
During acute rheumatic fever approximately 30 % of patients with
rheumatic carditis, predominantly males older than 20 years, develop
an incomplete and reversible atrioventricular block.
About 80 % of patients with Lyme carditis show a conduction
disturbance with frequent synkopes. Approximately 49 % have third, 16
% second and 12 % first degree atrioventricular block, which are
mostly reversible within two weeks.
Diphtheric myocarditis leads to atrioventricular conduction
disturbances in one third of all patients, whereby 50 % demonstrate
third degree atrioventricular block. Despite insertion of transvenous
pacemakers, mortality is almost 100 % in these patients.
Clinically relevant viral myocarditis can be caused a variety of
viruses. Many patients with viral myocarditis demonstrate right or
left bundle branch blocks, but few develop severe atrioventricular
conduction disturbances.
In locally uncontrolled cases of infective endocarditis annular
abscesses cause atrioventricular conduction disturbances in about 14 %
of patients with native valve endocarditis and about 21 % of patients
with prosthetic valve endocarditis. Most of them are observed later
than 30 days after the first manifestation of the endocarditis. Eighty
% develop a first or second degree av-block, and 20 % a complete heart
block.
Atrioventricular conduction disturbances caused by infective heart
disease mostly have a good prognosis and fortunately in most cases
need no or only a transient implantation of a transvenous pacemaker.
(CVE. 2005; 10 (1): 47-50)
Key words: inflammatory heart disease,
myocarditis, endocarditis, pancarditis, conduction disturbance
Cornelia Piper, M.D.
Department of Cardiology
Heart Center North Rhine-Westphalia
Ruhr University Bochum
Georgstr. 11
D-32545 Bad Oeynhausen
Germany
E-mail: cpiper@hdz-nrw.de
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