Pacemaker implantation in systemic sclerosis (SSc) patients with secondary complete heart block (CHB) may be a required procedure to avoid clinical complications, according to recent case report.
The case study, titled “Complete heart block in systemic sclerosis: A case report and literature review,” describes an SSc patient with CHB who showed improvements in his health after getting a pacemaker, highlighting the need for optimized patient follow-up and disease management. It was published in the journal Medicine.
Cardiac involvement is often asymptomatic and associated with poor prognosis in SSc patients. According to studies by EULAR scleroderma trials and research, cardiac-related complications affect more than 50 percent of SSc patients, and cause 26 percent of SSc-related deaths.
Arrhythmia is one of the defining symptoms of cardiac involvement, and can be caused by the blockage of electrical heart pulses that induce heartbeats. But although arrhythmia is common in SSc patients, development of secondary CHB is rare, affecting less than 2 percent of SSc patients.
Consequently, there is little knowledge about CHB disease mechanisms in SSc patients and optimal treatment options, such as pacemaker implantation.
To better understand the condition, a team in China has reported the clinical case of a 48-year-old man with diffuse SSc and secondary CHB, before and after he received a pacemaker.
The patient was diagnosed with SSc one year before hospital admission. He had a history of normal heart function, but was admitted after experiencing a slow heart rate in the previous month. The hospital diagnosed him with blockages in the right and left ventricle of the heart.
After a normal hospital follow-up, the patient was diagnosed with CHB based on electrocardiogram (ECG) examination.
The patient had a class II heart failure, according to New York Heart Association functional classification grading standards, indicating slight limitations in physical activity, resulting in fatigue, palpitation, and dyspnea (shortness of breath). He also had slight pulmonary fibrosis, mild immune cell abnormalities, and a slightly enlarged right atrium.
After CHB diagnosis, the patient received a dual chamber pacemaker to prevent further cardiovascular complications. Follow-ups at six and 18 months after pacemaker implantation showed that the patient was in good health, and could even go mountain climbing.
“The patient responded well to pacemaker implantation treatment, and his exertional dyspnea disappeared,” the researchers wrote.
They suggested that this case report confirms the benefits of pacemakers in these patients. Still, they note that a better understanding of the cause and development of cardiac involvement and arrhythmia secondary to SSc is important to manage the condition.
“Because it is a sporadic disease and there is a lack of large cohort study data, CHB in SSc is limited to case reports,” the team wrote, adding that “early diagnosis, timely and reasonable therapy are associated with a better prognosis.”
According to them, regular follow-up of SSc patients with secondary CHB is necessary to discover and manage possible complications in a timely manner.
Pacemaker implantation is a required procedure for patients with advanced heart blockage or CHB who experience symptoms such as a temporary loss of consciousness. But pacemaker implantation before symptoms arise can significantly reduce severe complications in patients with CHB.
“Pacemaker implantation might be unavoidable if CHB is secondary to SSc, even if it is asymptomatic,” the team concluded.