ATRIAL STANDSTILL AND COMPLETE HEART-BLOCK IN SYSTEMIC LUPUS-ERYTHEMATOSUS

Systemic lupus erythematosus is occasionally complicated by cardiomyopathy and rarely by heart block. Several types of abnormalities of myocardial conduction, including atrial stanstill, have not been seen previously in systemic lupus erythematosus. We present a case of systemic lupus erythematosus with atrial standstill and slowly progressive atrioventricular block documented by serial intracavitary electrocardiographic recordings. Defects in cardiac conduction in systemic lupus erythematosus may be secondary to arteritis, nodal inflammation or degeneration, or degeneration and fibrosis of connective tissue. Atrial standstill may result from diffuse fibrosis and degeneration of muscle cells. We believe that some combination of these pathologic changes was responsible for the defects in cardiac conduction that we found. Our patient documents the expected spectrum of defects in cardiac conduction (sinus nodal arrest, bradycardia-tachycardia syndrome, fascicular block, asystole, and atrial standstill) in systemic lupus erythematosus theoretically possible on the basis of the pathophysiology of pericarditis, cardiomyopathy, or abnormalities of connective tissue.